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/jD <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> >AV JOAOTIV COUNTY ENVIRONMENTAL HFALTII DEPARTNSENT 304 E W'ERFR AVE.-3'"Fl.-STO('KTON CA"202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR I%SPECTIO\S EXPIRES 1 YEAR FROM DATE ISSUED <br /> ADDRESS477 _ CITYIZIP L SN _ n <br /> CROSS S'rNEF.T 1-140f"OF APN 093- O 31 PA R('F.I.SIZE A? s <br /> OWNER NAYIE V\/6►7( flV ?-G-L-L. tV/1�rAt-.El j) hCV4� _' P`NO\F (JrV_ -,33 V �.f�}�� Y' <br /> OWNER ADDRESS Pam)447 N_/�'�.I1��w�Lr Q��(�R'D f,F/' CITY'/S A:rE ztP� pD�j/W `95�2 6 <br /> CONTRACTOR D A• 'P—AfmA✓ i * sara 1„4L/ PHONE .1`r6 ,/CJ 7 <br /> 40a0 N_ w IL✓50�., w .,�r�. Cam► <br /> CONTRACTOR ADDRF.iS CITY/STn'TFlLIP <br /> I.ICFI'ISF )6'42 OC-36 OTHER /'\ _ NLAI III F.R_W�'— _ E XPIRATIoNDATEj-uga— __ Z <br /> WATER TABLE.DEPTH: A CEOCRAPIIICALINFORMATION: Coordinate% X Y <br /> I ❑ PERC TEST(S) NLMBER LAND USE APPLICATION N <br /> TYPE OF WORK: U NEW INSTALLATION )K REPA12'ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE lb <br /> U REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UHTrs:-L NLMBER OF BEDROOMS: 3 NLIHBEROF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG—^ _ _ CAPACRY _ gal AUFCOMPARTMF.NTS <br /> ❑ CREASE TRAP TYPEiMFG CAPACITY_ Sal 00FC:OMPARIMENTS` <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL P. FOI:NOA'I ION P PROPERTY Llhr _R <br /> ❑ LIFT STATION Sta TYPE OF PUMP O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> - -- — — -- 3 <br /> C-- <br /> �,( � <br /> y X LEACH LINES E LEACHING CHAMBERS J6L '� #%LINES�_ LF.NGTII OP LINES p��R S <br /> DISCANCETO NEAREST WE:A. I O 4' ft FOUNUATION_ _ft PROPERTY LINE 51�T�1 1 R <br /> ❑ FILTER BED WIDTH_ _ _It LENGTH tl DEPTH R <br /> DISTANCE TO NEAREST WELL _ Il FOUNDATION ft PROPERTY LINE ti <br /> ❑ MOUNDED WIDTH ft LEN(rrH _ _ R DEPTH__ (1 <br /> DISTANCE TO NFARF-CI' WELL II FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH _it LENGTH. ft DEPrH R <br /> DISTANCE TO NEAREST WELL R FOUNDAIION_ LI PROPEK'rY LINE _ ft <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH l _ ft <br /> DISTANCE N�REST WELL ft FOUNDAT:ON 11 PROPERTY LINE _rl <br /> SEEPAGE PITS WIDTH %I ft LENGG:H tl DEP"rH 25 ft <br /> DISTANCE To NEA REST WELL JV+ (l FOUIDATION .J�/'+- -R PROPERTYLLNE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK W ILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> JII ``�f/'���j---'//{ STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQLIN COUNTY. <br /> \sG�J .�IM Y U 1 DYANCE NOTICE REQUIRED FOR IV%-e, 'ONS-P EASE CALL(2091 95 3-769 7 03 <br /> SIGNEl7l�JW <br /> vvv TITLE DATE <br /> F:.1T,L <br /> 0 I <br /> HF <br /> I I \ H a• ' <br /> DEPARTMENT USE ONLY <br /> Application Accepted Date ��- 03 Arta Z)1 Employee IDN_5��� <br /> Final Inspection By Dale S f"- c^ SPECIAL PERMIT•Approvcd by _ <br /> Character or Soil to pth 1 ❑or 3 FI: Pit/Sump Soil Character: <br /> COMMENTS <br /> PF. SC Received hec Amount Permit/ <br /> Code INFO B .ash Remitted Date Servlcc Request M Invoice N Permit IDN <br /> 2 1 IskaY51 V 5 3 1 <br /> 42-01-001 <br /> IA'2,102 ONSITF WAS"rF.W'ATER PERSin <br />