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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN Jr <br /> OAQUINCWNiv ENVIRONMENTAL HEALTH DEPARTMENT 300E WEBERAVE-3"OPL-6iacKTON CA 953U3 -(309)468J420 <br /> NUN-REFUNDABLE PERMIT ALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JO DDRE9s _ 114,111l i CMIZIPSI(Ckt(jn 9r7Z!5�_.�9 <br /> CORE STREET APN )GI C(t.. IMP 11 PARCELSIM O <br /> I O <br /> OWNER NAME fppbl PRONE I . <br /> O'1�:R AOORFSS Ij� A�Cfl^� CITY/SFATEIZIP SC�L(.Vlf (A <br /> Cu .ffOR A/ I PHONE - <br /> Cl-TRAcrO.ADDIRESS CRY/STATPIZIP <br /> L 4SE ❑C42 ❑C-36 OTHER r NUMBER EXPIRATION DATE <br /> IM TABLE DEPTH: ft GEOGRAPHIGLINFORMATION: CVaHYHn=he X V ". <br /> PERCTEST # BUILDIINGPERMIT# LAND USE APPLICATION# <br /> T EOFWORR: ❑ New INSTALLATION ElREPAIRIADDRIOn Ll ENGINEER DeslGneD/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION .I <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER — <br /> N O LV CUNITE• NIIMBEROF BEDROOMF: NUMBEROPEMPLOYEES: <br /> [I SEPTICTANK TYPEIMTG CAPACITY Be] #OFCOMPARTMENTS J <br /> GREASE TRAP TYPEIMFG CAPACITY Sel NOFCOMPARTMENTS <br /> ❑ PKG TX PLANT DIBTANCE TO NFARGST: WELL R FOUNDATION ft PROPERTY LINE fl <br /> L LIFT STATION S12E TYPE OP PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Lr LEACH LINES ❑ LEACHINGCHAMBERS #OFLwEE LENGTHOELINES ft <br /> DisTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE B <br /> L FILTER BED WRTB ft LENGTH ft DEPTH fl <br /> DISrANCETONEAREST WELL B FOUNDATION ft PROPERTY LINE ft <br /> MOUNDED WIDTH fi LENGTH ft DEPT fl <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> L DISTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> LT DISPOSAL PONDS WIDTH ft LENGTH R DEPT R <br /> DISTANCETONEARM WELL it MUNDATON ft PROPERTY LINE ft <br /> r SEEPAGE PITS NUMBER WIDTH ft DEPT fl <br /> DISTANCE TO NEAREST WELL fl FOUNDATION It PROPERTY LINE R <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCIT"ARCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 1f �MI`NI7I HOUR ADY ANCE NOT ICE REQU[RED FOR I NSPECTIONS-PLEASE CALL(209)953-0697 J <br /> r:NER `. TITLE iUr it DATE <br /> (�4) <br /> 23 MARIPOSA ROAD <br /> r 3.1O q <br /> F <br /> At <br /> l <br /> v 20.89 A4 IO V <br /> _ — 0 <br /> O <br /> 9 _ <br /> O e C s0 <br /> 67.74 A0. N pYMtN t <br /> N ` z MVu <br /> �� <br /> Be.BP at.Her <br /> Q AOUINMC'NT <br /> — p P <br /> DEPARTMENTUSE N��JrV [a�IIll <br /> eplication Actepteel By Dete /2 A,. Z (9 I., Y.ID# 11gq _ <br /> Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> -%acterof Soil to Depth Bf3 Ft Pit/Sump Soil Character: <br /> �COMMENTS <br /> �E SC Raaew;tl CChaMI Amount D h P=^niU Invoice# Permit lDp <br /> Cotte INPUCBeh Remiftetl SePviee R ueet# <br /> I /'3 h 5 405 3 <br /> I ONSITE WASTEWATER PERMIT <br /> il/li/2Wl <br />