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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUM'Y ENVtRONMF.NTAL HGuTN DEPARTMENT 3BAE WEBER AYE-T°PC-STOCKTON CA 95202 -(209)166-M20 <br /> NON-REFUNDABLE PERMIT CALL 209 951-7697 FOR INNPEC'TIONS EXPIRES I YEAR FROM DATE ISSUED <br /> Jos Ammumm, 8y/'J� , 1d9.1/� Cm/ZlP--'YY /�L -1 S�`�(J j <br /> CR095 STREET '/�2.It. /LO/'YIJ� AP.NO telPARCEL SIDE Pel <br /> OWNERNAME - :::rah- 14H ,7/on�// `PHONE <br /> OWNERADDRF_R9 CITY/STATE/ZIP <br /> CONTRACTOR I PHONE C <br /> CONTMCTORADBRF_53 CFTYAPTATFIZIP <br /> LICFNM: VCA2 0C-36 OTHER NUMBER E%PIMTgN DATE <br /> WATER TABLE DEPTH: R GEOORAPHICALINFORMATION: CeenfinateT X V <br /> ❑ PERC TEST # BUILDING PER MIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEWINSTAI.uiron REPAIRIADpmory Ll ENanEERDESIGNEDIALTERNATrvE <br /> ❑ REPLACEMENT ❑ Dmituc im <br /> INSTALLATION WILL SERVE: .✓172 REMDENCE ❑ COMMERCIAL O OTHER <br /> NUMSEROFLWINOUNTTS: / NUMBER OF BEDROOMS: NUMBER MEMPLOYEES: <br /> O SEPTIC TANK TYPE/MFG / CAPACITY GOO SRI EOFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPP/MFO CAPACITY Bel #OFCOMPARTMENTS <br /> ❑ PKG TX PLANT DISTAnCETONFARETn WELL /004 R FOUNDATION -90J ft PRDFERTY LINE ARO, R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES XLEACHING CHAMBERS NOF LINES <br /> A� LENGTH OF LINES <br /> ETT yO�t R <br /> DISTANCE TO NEAKWELL /00f ft FOUNDATION pOP ft PRCPERTYUME �JO, R <br /> ❑ FILTER BED WIDTH R LENGTH R DEPTH ft <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LONE '0 ft <br /> ❑ MOUNDED WIDTH ft LENGTH R OEM ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE fl <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS W. ft LENGTH ft DEPTH ft <br /> DISTANCETONEA�RRYEST WELL R FOUNDATION R PROPERTY UNE ft <br /> SEEPAGE PITH NUMB <br /> ---Q-- W-HPH 3 ft OEM <br /> DIHTANCETONEAREST WELL /ODA ' R FODNDATWN /a-T ft PROP�E E'7O A ft <br /> 1 HEREBY CERTIFY THAT I NAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REOUTATIONS OF SAN JOAQUIN COUNTY. <br /> .MINIMUM U HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-707 <br /> SIGNED ! TITLE /...s.¢.4 L>rei+- DATE /D <br /> YLJA <br /> 9L _—DEPART O. <br /> ApPlkMioo Ac9eptM E I le Area EmP1oYa IDM �' yL� <br /> PInAl lnapeclbnB Mte /G l' ❑ SPECIAL PERMIT-Appmvd by (( <br /> CEancterefSdib f]FD Ph/Sump SDll ChanmbT: <br /> COMMENTS 1 ��, AI R..Q CAti.P <br /> PE SC R.W. C, Amount DME PermiV IHYok.# PenI1HIM <br /> Cabe DIED By &Yvke R ueat# <br /> 43M401 ONSITE WASTEWATER PERMR <br /> IM24N10J <br />