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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIROWT..NTwL HEALTH DEPARTMENT 300E WEBER AVE-3"FL-STOCRTON CA 95202-(209)468-3421 <br /> NON-REFUNDABLE PERMIT CALL(209)9S3-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBAYDRESS 1,vo S01 Alf. Lewmalio Y ann/,✓ cITY(LIP r <br /> .�cI'l <br /> � p ra Ill or r-D u <br /> CROSS SCREET lJ e APN I PARCELSIM •45 n/,r e <br /> OWNERNAME ��0�A� PHONE '. <br /> OWNERADDRESS Cnw/STATC2IP C./1//, <br /> CONTRACTOR Ci4kd/ 11441 iLBs Iol PHONE <br /> CONTRACTON�(A f DDRESS /QO6 �. ��Q CITY/SYATULIP <br /> LICENSE ill (3 C-36 OTHER NUMBER O f.Z EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFURMATION: Coordinates X V <br /> ❑ PERC TEST(S) NUMBER LAFDUSEAPPLICATRJNJI <br /> TVPEOFWORK: /W NEW'INBIALLATION I] REPAIRIAMITIOY ❑ ENGINEERDEsIONEO/ALTRRNATD'/: <br /> ❑ REPLACEMENT O DESTRUCTION <br /> INSTAL=11.2 WILLSERVE: IST RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> Ar NUMBEHOF LIVING UNITE:_ 1 NUMBER OF BEDROOMS:---.9-/ NUMBER OF EMPLOYEES: <br /> pl SEPfICTANK TYPE/MFG Y�iFI!!// J/St✓oLj1 CAPACITY 16494P gal ROFCOMPAATMENTE_2 <br /> ❑ GREASETRAP TYPEIMF4 CAPACITY _ PI NOF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTAHGETD NGREET: WELL /dO It FOUNDATION 010 R PROPERTY LME 01f71 R <br /> ❑ LIFT STATION SIZE TYPEOFPUMP ❑ SAND OIL SEPARATOR(EINCLosm SYSTEM) (,* <br /> N <br /> eq LEACH LINES ❑ LEACHINCCHAMBERS NOF LINES _ LYNGDI Ur LINES S✓O / A <br /> DISTANCE TO NEAREST WELL SRO , R FOUNDATION SO R PROPERTY LME �S I ft <br /> ❑ FILTER BED W.mn N LENorH R DrErl ft <br /> DISTANCETONF.ARPtt WELL_ R FDUNDATIONft PROPERTY LINE D l- <br /> ❑ MOUNDED Wt.. B LFNYJTN R DEPTH R <br /> DISTANCETONEARESF am.a. fl FOUNDATION ft PROPERTYLINE A rTR <br /> ❑ sumps WIDTH R LENOTN It DEPTH it ,II <br /> DISTANCETONEARCST WELL _ft FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LEAOTII ft DEPTH it <br /> OISTANCETONEARWIF WELL R FOUNDATION R PROPERTY LINO R <br /> RI SEEPAGE PITS WIDTH If A LENGTH ft DEPTH -575"' ft _ <br /> DISTANCE TO NEAREST WELL ✓s/J.5- ft FOUNDATION 60'_R PROPERTY LINE. /SA <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. 1 <br /> STATE BAND RULF.SAN'D RFA:ULATIONS OF SAN JOAQUIN COUNTY. <br /> "IMUML ADV CE NOTICE NEQUIHEDFOR PNSPECI'IONS-PLEABE[AI.1.(2W)933-169] <br /> SIGNED TIME DATE <br /> ✓ E <br /> ENMWAFA Al <br /> I <br /> � Jr <br /> IF <br /> I E <br /> J <br /> - sl <br /> 1 <br /> / AC H EP ME <br /> DEPARTMENT LSE ONLV AF <br /> ApPlicatbn Ateepted Dale A. 2I Z Empl IDN .5310b 49 <br /> P101InlpedbnB Date /� ❑ SPECIAL PERMIT-Appruvedb, <br /> CNnctlr Df SDB m 91`3 Ft: Pit/Sump Seg Chaneter, <br /> PE SC Recdred Cb Almuat Data PErmlll IRYoke0 PermHIM <br /> Cade 'SC <br /> B orb REMNed Servke Ee uestM <br /> 421r 1 !l 330— 32- CNJ -le/o+6031 <br /> 1 <br />