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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY EWRONMENTAL HEALTH DEPARTMENT 1888 E.HA2ELTON AVEJAUE-8 f0cKTGN CA 95205-(209)4883420 <br /> NCIN-ReFuNaRaLE P$Rma CAU 209 353-7697 FOR INsIovCTfaNS EXPIRES 1 YEAR FROM DATE 15SLIEU <br /> JOB ADDRESS �3�C�13 �jS�st��• Cm'72/w <br /> CR4WS STREET w�'S.�Q-sc q APN_��� �[P D O .--P+V+CIEs.SRE O Q <br /> OWNER NAME e <br /> OWNER ADDRESS CiTYISTRTEItJP T <br /> CONTRACTOR 4 ,r L* L j� PHONE 9~!re <br /> J <br /> COWRACTOR ADDREaS 7'w/ [ &,w— LYTYISTRTFIOP <br /> LICENSE C0y42 peCas DTNFA NUMBER 46-py--c— ExPIRATIDN DATE. <br /> WATER TABLE DEyrN: ft GEOGRAPHICAL INFORYATICIN: CaOTdlnatM X Y <br /> PERC TEST 8; BUILT-G PERIIFfT O LAND USE APPIJCATI(N 9 <br /> TYPE OF WORK: NEW INSTALLATION REPARdAlimoN C ENGINEER DESIGNED IALTERNAVm <br /> s'. REPLACEMENT OLIT-01F.SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WALL SEkVE: ) RESIDENCERD" Cl CONMERC D OTHER <br /> NUMBER OF Lwm UNue., :9- NUMBER OF BFDROOMA5 NUMBER OF EYPLOYEEB: <br /> Pi SEPTIC TANK TYPEIMF-6 D/IY L CAPACITY 4 L gal #OF CoMPARTME3i15- <br /> O GREASE TRAP TYPEfMFG CAPACITY T gal #OF CcmPARTmaas <br /> DISTANCE TO NEAREST: WELL f R FOUNDATION S ft PROPERTY LINE �o! R <br /> k U LIFT STATION SIZE TYPE OF PUMP a PKG TX PLANT © SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> y7 LEACH LINES J LFAGHINGCHAMBERS #OF LINES ? <br /> IIIIII f ¢ LENGTH OF LINES "sT ft <br /> DISTANCE TP NEAREST WELL It FWNPATION I + ft PROPERTY UNE <br /> © FILTER BED WIDTH It LENGTH ft DEPTH It <br /> DISTANCE TO NEAAEST WELL ft FOUNDATION ft PROPFJi'i'V LINE R <br /> I] MOUNDED WIDTH ft LENGTH B DEPTH ft <br /> Dt9TANGE TO NEAREST WELL A FBuNmrw R PROPERTY LINE ft <br /> 0 SUhIPS w[Drn ft LENGTH ft DEF" ft <br /> DISTANCE To NEAREST WELL _ R FOUNDATIM ft VRpPERTY LINE ____ ft <br /> (] DISPOSAL PONDS wrorn_ ft LENGTH ft DEPTH ft <br /> �f DISTANCE TO NEAR WELL ft FO�iNDATION ft PRQPERTV LINE R <br /> OQ SEEPAGE PIPS NuI� VVVm $ A ft DEP7n ;A2r, f ry <br /> I' DISTANCE TOO l EARM WEWEi L_/;EO R FOUNDATION f S" it PROPERTY UWE <br /> r.EREBY CERTIFY THAT I HAVE PREPARED TKS APPLICATION AND THE WORK WILL BE DONE IN AC CORDAI4CE WITH SAN JOAOUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQU IN COUNTY. <br /> MINIMUM HOUR A OYANCE NOTICE REQUIRED FOR INSPECTIQIVS--PL 17A E 2 <br /> SIGNED TITLE_ 4Z4— __ DATE <br /> PAIL ENT U EO LY A <br /> AppNcatlan Accepted My Date ! Area Employe <br /> t <br /> Final inspection$y Dale C SPECIAL PERMrT-Approved Di <br /> Character of Soil to Depth Of 3 Ft: PItlSurnp Soil Character: <br /> COMMENTS _ 2)11% <br /> 1yTy <br /> 44 <br /> PE Sc PAicehredAmount PermjU <br /> Code INFO ff1-5e, <br /> 5ry &mI� Owe SeMce Rp pest* Invoice 0 Permit 4 <br /> 24[q--,qT + <br /> a2-01 ONSITE WASTEWATER TATMNi SYSTEM PERMIT <br /> anfrtS <br />