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y ' o' ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SANJOAQMN COUNTY ENVUtONMENTAL HEALTH DEPARTMENT 600E MAIN STREET-STOCKTON CA95202.(209)468-3420 1 <br /> NON-REFNNDAR PERM T ALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADUREFS •S _ CITY/ZIP IRA �mk <br /> CROSSSTHMT • r 3 Q PAR(/10ELI-SIIt1Z/E/F��/l1•- � pH <br /> 'OWNEBNAm ✓:+'W� - .arc - PHONE <br /> OWNERADDRESS - L �/ �/1�- ,F •CIIY/STATEMP /G) <br /> COMRAC R A ' 1• - I"NE <br /> COWRACT�O[RADDAE55 av 1 �!� CINISTATE/ZV. <br /> LICENSE pl C42 0 C36 OTHER Nul&BER NVO� xPIRATIONDATE t'y <br /> 07 <br /> WATERTABLEDEPTH: R GEOGMPHICALINFORMAIION: CODr411O0I0 X Y . <br /> j O PERC TEST M. . BUH,DING PERMR# - .LAND USE APPLICATION# <br /> S TYPE OF WORK: O NEW INSTALLATION - REPNWADDI'II�ON/ - - _ O {g�GI E ESIG FIp//pLTERNATIVB <br /> O REPLACEMENT /P DESTRUCTION- LV <br /> . U1STA,1=n0NWILL SERVE: '- QRESIDENCE' - O-COMMERCIAL <br /> NUMB ER OFLMNG UNITE: NUMBEROFBEDROOMS: •� ' `N EROFEMPLOVEES: <br /> SEPTICTANK TYPF/MFG J - C ACHY #OFCOMPAEi &N S ' <br /> 0 'GREASETRAP TYPF/MFG CAPA J. BE] #OF COMPARTh07lTS <br /> I,r UISTANCETONEARESF: WELL 1 1 , R FOUNDATION I It PROPERTT TL E ft <br /> O LIFTSTATION" SIM TYPEOIPUnv - - O PEG PLAW 'SANDOILSPJ'AAATOR(ENC SYST <br /> i `1, LEACHLINES �# LEACHINGCHAMBERS #OFI.IN S- "LENGTH OF LEUE$ R 1 <br /> DISTANCE TO NEAREST ' WELL R' FOUNDATION R ' PAOPERTYLWE <br /> O FILTER BED W ft LENGTH R DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPMW LINE ft <br /> 0 MOUNDED Wmm ft LENGTH ft DEPTH ft <br /> DISTANCETONEAEMT WELL R FOUNDATION " R PROPERTY LINE It <br /> 1 Cl SUMPS WRDB ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft. FOUNDATION . ft PROPERTYLWE ft <br /> O DISPOSAL PONDS Wmrn ft LENGTH ft DEPTH ft <br /> DISTANCETONEAEMT WELL t, -ft- FOUNDATION ft- -' MOPERTYI.NE ft <br /> ,O SEEPAGE PITS NDMBER WmTH - ft • -DEEM- t "ft <br /> DISTANCE TO NEABEST WEG, ft R)UNDATION ft PROPERWLINE ft <br /> I ,REBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> P 11J�1p1g1't ' 'jN151 ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 1 SIONEI�YY/IO J�J � L �ENOTICE RFQNRED FO I +C S ONS-P E(209)953-760 <br /> TI DATE I' lV 1 <br /> .. t <br /> MENNEN <br /> MEMEME <br /> MEMEME <br /> MEMENg <br /> EMMONS <br /> MENNEN <br /> MEMEME <br /> MONSON <br /> EME <br />' A NT <br /> MONERSi o <br /> O07 <br /> MEMNOW C UNpy <br /> EMEM <br /> MENNEN <br /> EMMONS <br /> m..ApplieekioR#aeeptM - •->�F Detei. _ !a _ c r•uYu+�>LYF. f4�2 <br /> FIRM IRspcedoB By Date` I]'SPECIAL -Approved by <br /> China"Of Soil to tho - - Chm.ma: <br /> COMMENTS : <br /> G � <br /> PE SC Rcetl ed C o AnwuR[ Date Perm1U Iovofce Permit lDO <br /> Code INFO CRsh no Ned - Seivice Re ueat# <br /> �4 <br /> A I <br /> 4022-01 ONSIiE WASTEWATER PERMR <br /> Imo'!!• ON wow / <br />