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ONSITE W STEWATER TREATMENT SYSTEM PF^,NIIT <br /> SAHJOAQUIY COUNTY ENVIRONSIENT..AL H` `DEPARTMENT 304 E WEBER AYE-3-°F xi0V CA 95202-(209)"S-3420 <br /> NON-REFUNDABLE PERMIT �/ CALL(209)953-7697 FOR INSFE(TIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS . - �yCRV21P <br /> L CROSSSTREE AP V :�I 6ARCEL SI 1 I �IIr]IIIc <br /> O,NLRNAJIE 11/-�'.•J..I(ll (I iUCIC; PH06E N ':.y <br /> ON'NEA ADORES$ I JI J -u I h It 33 CRYSTATFlLIP 4)11)1 Ncl6,l CAIty3J-� <br /> L NctI GAidcrDi ' ,�CCI.�1-'; -Z �(r7-z570 tal <br /> CONTRACTOR (� T 1 -T (1J 1 PHONE" �y)� 1) /� <br /> CO.YTRALT00.ADDRESS IV.7 111 � �f 1'iI V_Lj\( CRYISTATFIZIP Lr Ili !✓DL`)a+ <br /> LICENSE ❑C42 ❑C-36 OTHER - NW18ER EXPIRATION DATE <br /> L WATER TABLE DEPTH: GEOGRAPHICALINFOANATION: CPVAiR2le5 X Y <br /> PERCTEST(S) NUMBER rp LAND USE APPLICATION,. <br /> TYPE OF WORK: ❑ NEW INSTALWTON ❑ REPAIWADDITION Cl ENGINEER DESIGNED/ALTERNATIVE <br /> Cl REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NURIBEROPBEDROOMS: NUMBEROFEMPLOYEES: <br /> ❑ SEPTICTANK TYPEMFO CAPACITY gal i OFCOMPARTMENTS <br /> ❑ CREASE TRAP TYP-', FG CAPACITY gel `n OFCOaIPARTPIENTS <br /> L ❑ PKG TX PLANT DISTANCETONEAREST: WELL R FWNOATnN IT PROPERTY LINE a <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(EHCLOSEDSYSrEoQ <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS NOFLMES IENGiNO.LINEs ft <br /> LDlsTANCETONEAefST WELL B FOUNDATION R PROPERTY LME <br /> ❑ FILTER BED WIDTH ft LENGTH fi DEPTH R <br /> DISTANCETONEAREST WELLR FOUNDATION fl PROPERTY LINE R <br /> L ❑ MOUNDED WIDTH ft LENGTH it DEPTH 4 (t <br /> DW YCBTON"Tem WELL R FOUNDATION IT PROPERTY LINE It <br /> ❑ sTjmP5 WIDTH it LENGTH R DEPTH f1 <br /> DFRANCETONEARESE WELL R FOUNDATION R PROPERTY LINE fl <br /> L ClDISPOSAL PONDS W. R LENGTH ft DEPTH H <br /> DISTANCETONEAREST WELL R FOUNDATION B PROPERTYLINE D <br /> ❑ SEEPAGE PITS WIDTH R LENGTH R DEPTH R <br /> t DISTANCE TO NEAREST WE4 R FWNDATION H PROPERTY LINE fl <br /> 1 IHEREBY CEA THAT I HAVE PREPARED THIS APPLICATION AND THE%ORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> [` �� �jjp /)�pp1Sll11 �3�ST�.A�TE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED ' "`^� \' HOUR <br /> SADVANCE NOTICE REQUIRED FOR TITLENSPEGTIOf`1^P).E.tSI:G\I,L('_PNIYS3-7697 <br /> DATE <br /> C Y I <br /> i't ®naI <br /> YT µ <br /> LE <br /> P <br /> ®"art.H <br /> PPru16 <br /> ❑o c <br /> iA <br /> 4 <br /> C <br /> eq <br /> 06 <br /> DEPARTMEN US ON Y t} 1 cc <br /> bm APPiic 1 o Accepted BY _ Ded,_ 8 25 0 Aree / EmplaYee IDK �� 'o <br /> Fina11K5pectieD BY Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of3 FV PIUSvmp SDH Character: <br /> COMMENTS <br /> L PE SC Ro med �SBeckKi' Amount Permiu <br /> ale In(nittK PermitlDK <br /> Code INPO Las � Remitted V / .r Sen ice Re oestk <br /> 4t' <br /> 2 I WI <br /> 12^..D3 ONSITE WASTEWATER PERMIT <br />