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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WERERAVE-.Y°PL-STOCKTOX CA 93202 -(209)468-3420 <br /> NON-REFUNDAB <br /> ILlE PERMIT CALL 209 953-7697 FOR INSPECTIONS 1 EXPIRES I YEAR FROM DATE <br /> 23-7 ISSUED <br /> JOBADDUM LDO od a Crn/,r 1-OG�I=FyA A 9523 / <br /> CROSS STRCET DO -'1 APN os-I- 2.]Ei"'O PARCELSIM <br /> OWNERNAME �r/�-1�( Df./ b 1\ V e-A PHONE (4ok�/lgk/z�--)33k <br /> OWNERADDRF6& 514 446 N'EAM CITY/STATE/,, GI(-¢O� 1 CA -15b2-0 <br /> 15b2-0 <br /> CONTRAROR PHONE <br /> CONTRALTOR ADORE$ Cm7RTAT ErIAP <br /> LecrNsE Ll C42 Cl C-36 "ES NUMBER EEPIRATIONDATC <br /> WATERTARLEDRPmtt R GEOCRAPHICALININD MATION: Conrdlasks X Y <br /> ❑ PERCTEST R h� S-1)BUILDING PERMIT M LAND USE APPLICATION B <br /> TYPEOPWORK: NEW INBTAWTON ❑ REFAIWADYITION ❑ ENGMEERDESICNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DEATRDCIION <br /> INSTALLA WILL SERVE: (3RESIDENCE ❑ COMMERCIAL ❑ OMER <br /> NUMBER OF LIVINGUNrf6: NUMBER OF BEDRWMB: NUMBEROPEMPLOYEEF: <br /> ❑ SEPTIC TANK TYPE/MPO CAPACITY Be] 0 OF COMPARTMENTS <br /> (3 GREASE TRAP TYPE/NfM CAPACITY 8rI ROF COMPARTMENTS <br /> ❑ PKG TX PLANT DISrANCETONUREsr: WELL R FOUNDATION A PROPERTY LINE B <br /> ❑ LIFT STATION Sim TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENcwms,SYSTEM) <br /> O LEACH LINES O LEACHINCCHAMBERS ROFLINES LEwOi0FLINES fl <br /> DIREANCETONEAREtT WELL R FOUNDATION ft PROPERTYLOIE R N <br /> ❑ FILTER BED WIFM fl LENGTH R DEPTH IT <br /> a <br /> DIRTANCE IO NFAR[B! wED. R r9UNDATION fl PROPERTY,RIE fl OCI <br /> ❑ MOUNDED WIDrx ft LENGTH fl DEPTH II ib <br /> DISTANCETONEAREST WELL R FOUNDATI01I R MOrERTY UNE ft <br /> ❑ SUMPS WIoTN fl LENOIR R DEPTH IT <br /> DISTANCETONEAREST WELL R MUNDATION fl PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENQM It DEM R 2 <br /> DIWANCETONEAREW WELL D MUNDATION R PROPERTY LME It O <br /> ❑ SEEPAGE PITS NUMBER WmTN U DEPTH IT 2i <br /> DISTARLETONEAREBT WELL ft FOUNDATION ft PROPERTYLINE If I`E <br /> V <br /> 1 HEREBY CERTIFY THAT HAVE PREPARED TAPPLICATION AND WORK WILL BE ACCORDANCE WIT'tl BAN JOAQUIN COUNTY <br /> R <br /> ORDINANCESTATETE TAWS AND RULES ANO"RLGULATIONS OF SAN EAN JOAQUIN COUNTY. <br /> M Imup92 LOUR ADVANCE NOT ICE REQUIRED FOR INSPEC�TIIONS-PLEASE CALL GN)9534697 <br /> SIGNED Y TITLE 'tU U'L/ DATE A 1 0S/ <br /> a <br /> DEPARTMENT 111SE p6sV <br /> Application AccepteI <br /> DRte ff(aS Alra EnploYce lDR 53&& 9� <br /> F/DRI InTpertbD By DRb ❑ SPECIAL PERMIT-Approved by <br /> ChRocter of Solt to Depth of 3 FU PH/Sump Soft ChBnC(er: <br /> COMMENTS 0LuT-Or- 4:�&IeveeE SIE,072[ S7)fS1£H SqEiTG S�sTEM <br /> /JL/OE.0 A ,6 T rg(r IIV A-J4 "?A44" a AJOF—,E T"c.Pu T )� eST�3ztrF3 <br /> PE 6C RaeWed Cbecld'/ Amount Do_ PRrml IRvo1CeM Prrmit HDR <br /> Code INTO B CRsn Remllted Serv1u R u.D N <br /> A2L2-0DI ONSITE WASTEWATER PERMIT <br /> IL32rlORl <br />