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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIHONMEDTAL HEALYN DEPARTMENT 1006 E.HA>.ELTONAVENUE-STOCKTON CA 0520 -(209)468-3-020 <br /> NON•REFUNERMI CAL _2_0.9195. -76.97 FOR INSPECTIONS EXPIRES 1 YEA R,O TE I_SSU_EU <br /> Joe AOBUESS _ CITYIZI Z V, <br /> CROSS STFEETTT_ _. / APVM 4 _. C`7; Y <br /> yy, q�, _-PARCEL(S�I2F/,P a <br /> OWNER NAMIL /�L� ;� C+1�J'1.G( l'1!/SJ- _ 1 --"' ..__PHONEC -L .L <br /> OWNER ADDRESS"'[ .Ic�Y'f F✓J-_ f -. __CITY/STATE Pl A {-��`✓ C� W <br /> CONTRACTOR D,A P5427-A <br /> CONTE <br /> ACTOfl ADBR[SS 4 . ,,D WIS./ Fy'� __CRYISTATL2IP V IO1��� D" q5205 <br /> LICE14SE AOC-42 OnC-36 OTHER___A____ NIIIAUFD 0051_ _EXPIRATIONDATE J <br /> WATER TABLE DEPTH(' .:.:_It. GEOGRAPHICAL INFORMATIOM Coordinates X_ _ Y _ <br /> CU PEflC TEST # . BUILDING PERMIT IF - LAND USE APPLICATIONN <br /> TYPE OF WORK: Ii NEW INSTALLATION II REPAINADIll r10N 1�1/ ENGINEER DESIGNED/ALTERNATIVE <br /> IT PREPLACEMENT -_ __--._ ❑ OUT-OF-SERVICE SEPTIC SYSTEM IW DESIRUCTIO14 <br /> �ALLATION WILL SERVE: M RESIDENCE I I COFAMERDIM1L O OTHER <br /> INST <br /> NUMBEROFLIVINGUNITS: _ Numurn OF BEnnOOMS. _ NUMBER OF EMPIAYFLS <br /> SEPTIC TANK TYPE/MFG _ � .-.. CAPACITY Ta gal U OF COMPARTMENTS <br /> ❑ GREASETRAP TYPHMFQ _._.......__ +-J�_.�-__ _ CAVALRY_..........___-- _ gal It OF COMPARTI..IrMTs <br /> DISTANCE TO NEAREST: WELL `.(„J it FOUNDATION_ it PROPERTY LINE H <br /> ❑, LIFTSTATION SIZE TYPE OF PUMP____ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> L LEACHLINES -V LEACHINGCHAMBERSGlG2.j If of LINES ' LENGTI IOFLIwe It <br /> DISTANCE To NEAREST WELL-� J _ 11 FOUNDATION-125"r- _it PHOPERTYLINE—A... `}.'._ .. It <br /> ❑ FILTER BED WIDTH _It LENGTH -.__it DEPTH _________it <br /> DISTANCE TO NEAREST WELL___ it POUNDA NON _it PROPERTYLINE_ it <br /> ❑ MOUNDED WIDTH it LENGTH -It DEPTH It <br /> DISTANCE To BEADES•T./� WELL-- it I'AINOAPON_ it PROPERTYUNE It <br /> SUMPS WIDTH f; it LVV61`y._ _. R ..._. DEPTH <br /> DISTANCE TO NEAREST WELL_ /bD_ It FOUNDATION it PROPERTY T- <br /> _11 <br /> ❑ DISPOSAL PONDS WIDTH .___. _It LLNOTH fl DEPTH RECEIVED it <br /> DISTANCE TO NEAREST WELL— It FOUNDATIONit PROPEINYLINE_WV_+ 911F.1_it <br /> LlSEEPAGEPITS NUMBER WIDm :.__.__..____ it DEPTH__.._._.____- O LU IY it <br /> DISTANCE TO NEAREST WELL It I'OUIIOAOON_._.._..__ t it PHOPEnrYESIILN JOAQUIN COUNTY <br /> W..........e_..___.,..,._.._._....._.,._..k_...._._..-..__............._`.. ..........::..... 1-- <br /> IHEREBYCERTIFY TI4ATIHAVE PREPARED THIS APPLICATION AND THE WORK WILL DEDONE INACCORDANCE WITH SAN JOAOUMfF/91fFJiM OWA44VM EENT <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> I A�MHJkM 224 hOO"�6QAAlOt4CE REOUa[i <br /> lEl3 OR <br /> S _CTIO ASE CALL 2099.5a-769 <br /> SIONE Ww_1J. S/LIX _ TTL DATE '' _14- <br /> 211, <br /> 14211' <br /> r t •—ExxrSrlNc- . <br /> tccu La-w <br /> 'i>-L ID' <br /> ` bPA RTMF,NT�I$E ONIsY <br /> ApplicationEmployee 10 ��T <br /> Final inspection ByZ ' ,��)t- `L „- ,c� Dote l Z�� ❑ SPECIAL PERMIT-APProvod by --......... <br /> Cheracler of Soil to D th ol3 Fh_.___ __-___. PIVSump Soil Cheracmr: __ <br /> �� rr���T:i.�rr���✓�-srl<L�'--- <br /> .�r2..�-</�. - <br /> PE SC Received LC,]Ec4B1 Alneunl Permit/ <br /> Dnle Invoice U Permit lDq <br /> Code INFO D Gish Remitters Service Fler uosi n <br /> -� o _ <br /> 42.01 ONSITE WAS rEWATER TFITMNT SYSTEM PERMIT <br /> -1124112 <br />