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' 6P 1* UaO 37.-k <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTYENVIRONMENI'AL HEALTH DEFARI'MEW 30d E WEBER AVE-3—FL-STOCKTON CA 95202 - (209)46&3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> 1 � n <br /> Joe wopat'as CrrvrelP _ <br /> CROSS STREET 4f 141"J"o APN X63 -23C - 3-7PARCF.I.SIEE e <br /> OWNER NAME �i1p0'1'Y)'1 �Fj/)i'.O�fi J3)2 1/ BP-o2o�3188 yP,RU1N, TIr <br /> ' OWNER ADD I% ICLS I] ri4olVeil ` ir CITYSrATFILIP TNCKTDh <br /> CONTRACTOR _CG1�no/ fl.�.zs^/� / PHONE Si -Soz7 N <br /> CONTRACTORADME,Ui 7t Z / / ? LAIT/C CITvtSTA'I'FILIP N <br /> ' I LICENSE WC42 ❑C-J6 OTHEA NUMBER S1D�/Y� E%PIMbM DATE <br /> WATERTABLEDEPFH: R GEOGRAPHICALINFORMATION: CD..dilleler X Y <br /> ❑ PERCTEST(S) NUMBER LAND USE APPLICATION B <br /> TYPE OF WORK: IIL. NEWINSTAILATION ❑ REPAIWADDTTION ❑ ENCINCERDESWNLOIALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION wILL SERVE: IZRESIOENCE ❑ COMMERCIAL ❑ OTHER S <br /> NUMBE0.0P LIVING UNITS: NUMBER OF BEDROOMS' NUMBER OF EMPLOYEES: <br /> ' SEPTICTANK TVPEIMFO CAPACITY 4;�.�] 991 MOFCOMPAR'rMENTS O^ <br /> Cl GREASETRAP TVPEIMFO CAPACITY Eli NOFCUMPARTMENTS <br /> ❑ PKG TX PLANT DHTANCETONEARE.ST: WELL 'sL��+' H FOUNDATION /(J I1 PROPERTY LINE <br /> ❑ LIFT STATION Siu TVPEOFPUMI ❑ SAND 011,SEPARATOR(ENCLOEEDSnTEM) 5 <br /> LEACH LINES ❑ LEACHING CHAMBERS NOF LINES�_ LENGTH OF LINES rfO e ft <br /> DIStANCEMNEARESr WRIT. FOUNDATION Ott'' _R PROPERTYLINE <br /> ❑ FILTER BED WIDTH R LENGTH H DEPTH ft <br /> t DISTANCEMNEARAT WELL R FOUNDATION ft PROPERTYLINE ft <br /> ❑ MOUNDED WIDTH R LEND R DFPTH D <br /> DISTANCEMNEAREST WELL fl FOUNDATION ft PROPERTY LME It <br /> ❑ SUMPS WIDTH R LENGTH_ it DEPTH ft <br /> DISTANCE M NEAREST WELL _0 FOUNDATION R PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH B LENGIH H DEPTH D <br /> DISTANCE M NEAREST WELL R FOUNDATION O PROPERTY LINE Fl <br /> SEEPAGE PITS WIDTH �i�11 R LENGTH fl Derrn ag D <br /> ' <br /> DISTANCE m NEAREST WELL 3CO f it FOUNDATION �JS� It PROPERTY LME S B <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THISAPPLICATION AND THE WORK WILL BE DONE.IN ACCORDANCE WITH RAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINI MUMM HOUR ADVANCE NOTICE REONRED FOR INSPECTIO//NS-PLEASE CALL(20))953.7697 <br /> SIGNED _ TITLE DATE SZZ.4S <br /> ej <br /> E <br /> E EIVIEU <br /> ' L 79T- <br /> rFs <br /> Fo mlE rAl Ne m+ <br /> rd <br /> u <br /> DEPARTMENT USE ONLY j(( <br /> Application Accepted By \lUlAwfL lIV(IAJU.I,� DRIB -'der Agee r-�7-- Employee lDp_�J Vr+ <br /> ' Fluid Impeelion BY. Date ❑ SPECIAL PERMIT-Approvedby <br /> ChaocHrof Soil lD Depth If3 Fly- Pit/Sump Soil Chancier: <br /> COMMENTS S ti <br /> ' PE EC Meet, C Amount Dah Permit/ InvoiceN Per lDN <br /> CBda INFO B CaI Remitted ry u e <br /> 'LII 1 3ao.m 7zp r S o 33��2 <br /> ' <br /> RAI-001 <br /> 2-OL- <br /> ONSITE WASTEWATER PERMIT <br /> 4 <br />