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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT' 304EWEBERAVE-3'FL-STOC 4CA95202 (209)468,MO <br /> NON-REFUNDABLE PERMIT �j(� /CSA{L5L-(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRF.53 2�)5 f]>JJ p-AlFPS�--�RTT6/I CmruP DEKi�TC7TNI /(� m <br /> • CROSS STREET �ACcefyr C1JN.�-.'�f16oLX--Ib ` /�� APN I�A, �Z�IO^I `P'A(RTCEEL SICE y1/`�p <br /> OWMER NAA,E TIS�'o�//fJE"11TIIAT�v.."1M}-."jJ�Tkl� jwf T'f�p " -L:i C'F14q?PJN�',1..L4cI,,gj Z a I1� ISa -F <br /> OW.YERAODRM I'-'T'IT (�rLT, y)ym Tyr E-%?�.D�yel` Cm/STATEMP "o AS /z�A�-'�pON/�fT(J�-TI� 13,5I? 1 • <br /> CONTMCTOR Yf YGUJEIc�'r�l,'l^/ -� (�'..J�V�Ty"�'F�\ L+je, 4lPNNOO.N.F VTJrJ Y�IF.JA�C+ (� <br /> CONTRACTORADDRESS 15JI N• E'SRl/T\YWky RVOT .�E CITYISTTAATTEI(ZI]P" e.T_ oi,3 d 4+005 <br /> LlcevaE WtC42 OC-36 OTHER NUMBER f6`r�S EXPIRATIONDATE o�J <br /> WATERTABLEDEPTH: R CEOGRAPHICALINFORMATION: CoordinakJ X Y_ <br /> ❑ FERC TEST(� NUMBER LAND USE APPLICATION N 'SN <br /> TVPEOFWORK: NEWINSTALLATION ❑ REPAIRIADDHION ❑ ENGINEERDUMNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTR ON _ <br /> INSTALLATION WVIILL SERVE: ®L RLaIDENCE ❑ COMMERCIAL 2 [3 "ER_ <br /> NDMBEROP LING UNITS: �.,.I��p��� NUMBER Of BEDROOMS' J NUMBER OF EMPLOYEES: Y/ <br /> SEPTICTANK TYPEJIJV P•E�'oA0 ' � L CAPACITY �1 SOF COMPARTMENTa <br /> MFG <br /> ❑ CREASE TRAP TYPFJMFO_ CAPACRY SDI 90FCOMPARTMENTS <br /> ❑ PKC TX PLANT DISIANLR TONEA0.EST: WELL fl FOUNDATION PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSEUSYSTEM) Vl <br /> ❑ LEACH LINES Qt LEACHING CHAMBERS OF LIKE fENOTH OF LINES <br /> DISTANCETO NEAREST <br /> WE FOUNDATN)N2e!5' ft PROPERTY LINE {DOT R <br /> 7. <br /> ❑ FILTERBED WIDTx R i.EM1OTH R DEM R <br /> DISTANCETONEAREST WELL ft FOUNDATION_ft FROPERW LME R <br /> ❑ MOUNDED WmcH ft CSNGTH _D DEM R <br /> DLSTANCE TO NEAREST WECL__ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS Wuyni ft LENGTH R DEPTH ft <br /> DMANCETONEAREST WELL R FOUNDATION_ ft PROPERTY LME ft <br /> ❑ DISPOSAL PONDS Wmrx ft LENOIR ft DFPDI ft <br /> DISfANCETONEAREST, WELL—ft POWDATION ft PROPERTY LINE ft <br /> '& SEEPAGE PITS W.. 3(o e towa 3 ft DEPTH ZSR <br /> DLSTANCETONMREST WELL )pp }} ft FOUNDATION I DI R PROPERTY LINE ICK R <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITHSAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAV/S AND RULES AND REGULATIONS OFSAN JOAQUIN COUNTY. <br /> NH VM M HYOURADVANCE NOTICE REQUIREDFOR INSPPECCTIONNSSp-PLLEEA.SSEECCALL(209)953-7697 <br /> SICNED � 1 TITLE DATE <br /> FTT <br /> V <br /> 0' <br /> Y u NA <br /> III C NI <br /> NFA <br /> d <br /> DEPARTMENTUSEONLV 1 <br /> AppikaHOR AcmANNI B _V f ' 1 t Dake{ ) 'Ll ,L Arca —I i ftpl Yre IDB_5444t . <br /> FIDJ <br /> Ins .36 Dale 9'�9�i [3 SPECIAL PERMIT-AIWra'T4 by <br /> Chanekr of SOD to De Ihor3F0 mSumPSPil Cbamw r: <br /> COMMENTS /Y/!d/L<+.44421�.Ltl�Yl a-S"3�.rf��L4.vt/"lCt7 TG�.� '-•aF t—r..T.a.:fl—.orr <br /> • PE SC ReaiveD A..R' D k PermlV IaralnR Peewh IDB <br /> Code Iwo Ramllhtl Mee Re De <br /> 3537 1 I <br /> A2-0I-0M ONSITE WASTEWATER PERMIT <br /> 11201 —� <br />