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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 301E WEBER AVE-3"'FL.-STUCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE`ISSUED <br /> JOBADBRESS ..I-Ila 1V O�r+-f/ CITYMP <br /> APN Ot7—Z3U-IZ PARCELSILE t7 AC�F/S b <br /> CRISMSTREET {dpi <br /> OWNERNAME yKP`J'a PHONE �g <br /> OWNRRADDRESS I'I I19 Ra-C�t. =ojxl & CHY/SEATEILIP <br /> G <br /> CONTRACTOR c]TR-IR-'I J ��.�C t,P�N.O,N�Ey��+v,+=Lq��✓ <br /> COHTNACrOFADDRESS IS5( I�r�FWRLWTTT PCQfi� _ CITYY/STATEJZIP �tVe..F--1V AJ�ll1. C <br /> LICEPAR OCC42 ❑C-36 OTHF-R NUMBER L�./LCJ EXPIRATION DATE 0J <br /> WATERTABLEDEFF": It GEOGRAPHICALINPORMATION! Cvurd'matn X V- <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPEOP\YORK: ❑ NEWINSTALLATUON L( REPAIRJADDHION ❑ ENGINEERDEMGNEB/ALTERNATIvR <br /> O REPLACEMENT O DESTRUCTION <br /> INSTALLATION WILL SERVE: 1❑1 RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: ♦�yL�.1T'� �NU-�M-�B�EER��OO�IFI.,-H�£DROOMS: II ,�VA^^ NUMBEROFEMPLOVERM <br /> ❑ SEPTIC TANK TYPOMFO T/A.v5rI11.,`OII.JLAC.lI.1E� CAPACITY gat #OFCOMPARTNIENTS Z <br /> ❑ GREASETRAP TvPE/MFG_ CAPACITY gat #OF COMPARTMENTS <br /> ❑ TWO TX PLANT DIETANCETONEAREm WELL R FOUNDATION R PROPERTY LINE R <br /> 1 ❑ LIFT STATION SHE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCL(SED SYSTEM) <br /> )l J <br /> ❑ LEACH LINES IBI LEACHING CHAMBERS�KJJc�.WT'tTF" #OF LINES_/�'Z- LENGTH OF LINES 0 R (� <br /> D16TANCHTONEAREST WF_L I J�+T'F fl FOUNDATION�...._�R PROPERTY LINE LV r 0 b <br /> ❑ FILTER BED W.. ft LENGTH N DEPTH ft <br /> DISTANCETONEAREST WELL ft FOUNDATION_ ft PROPERTY LINE ft <br /> ❑ MOUNDED WHITN R LENGTH _R DEPTH It <br /> DHTANCETONEAREST WELL. ft FWNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WmTll ft LENGTH _R DEPTH R <br /> D16TANCETONEARESP WELL _R FOUNDATION fl PROPERWLINE R <br /> (3 DISPOSAL PONDS WMH R LENGTH_ ft DEPTH ft <br /> DISTANCETONEA Surr WELL ft FOV�MfATMN R PROPERTY LINE R <br /> 9 SEEPAGE PITS Wi. JPO I M—61BI1616L � 4- f DEPTH 2-15 �J R <br /> DISTANCETONEARFST WELL 1'90 'IP ft FOUNDATION IO' ft PROPERTYLINE 4�/t ft <br /> I HEREBYCERTIPYTHATI HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> GMININIIMUMMUU HOUR ADVANCE NOTICE REQUIRED MR INSPECTIONS-PLEASE <br /> ECCALL(209)953-7697 <br /> SIGNED "F�—CII�N _ TITLE_Com+, �•"�` DATE YLAJV�- <br /> r -1 <br /> Y <br /> CI <br /> N <br /> No <br /> 1 <br /> I/EPARTME USE ONLY L/ e <br /> ApplieaHon Aoeepted IS DMe Alee Zl�i - Employcc lDN_ .J310(+ <br /> PlnaunfpoHoonl6tDfe ❑tSerP:E_CIAL_PERM�T«TWd�by <br /> ChnlPiUSOmP Sall Charac <br /> COMMENTS _ / 6 — <br /> adrLi.� 2 WD.LJ- le k./ 7'- 2 j6 fiJ/ 'I DT reL0 0( ./.4 •e it n�T� )oa....Lc <br /> sA a . us+ <br /> PE Be Received Chemount Date Ivvvlce# Permil IN <br /> Code ISM B MR Remllled rYtre Re Be <br /> 42-IU Its Lit) 38'10 !Bu•x0 'N D <br /> 4241 <br /> 2rtro��-xfn ash jL✓J XaS�.C7�1=Tj r�"lo. `�r„CG� 6+BrzvrRSE¢P�A� <br />