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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 301E WEBER AVE-3"Pl.-STouOON CA 95242-(209)16&.3,120 <br /> NON-REFUNDABLE PERMIT�/y� CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEA FROM DATE ISSUED <br /> JORADDRESS f/(/V G Cf1Y2R � S _ <br /> CRIME STREET J �4HaNNT lJD AIN FE <br /> Nrxt;sv 12-0 OC_ <br /> rOM'NP.R NAME _ JOG S,I✓z /PPJJH��ON�EE ;n d/ ' <br /> OWNERAGDRESS Al 7Wr Ad <br /> CRY/STATF2IY /JG.IYM ��0 HHH <br /> r CONI'MCMR I/I PHONE O �y-I-� <br /> I COMAALTOR ApOREA O CRYISTATV21P <br /> I <br /> LICEHSC UC42 3C-36 OTHER NUMBER ERpIRATIONDATE <br /> WATER TABLE DEPTH: fI CEIX:RAPNICAL INpORMATION: CO didlnerG <br /> )[, P¢RC TEST N_ � BUILDING PEAMR# LAND USE APPLICATION# ' —O`�-30/ <br /> TYPE OF WORK: U New INSTALLATION ❑ REPAIWADDMION O ENGINPERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT Cl DESTRUCTION <br /> INSTALLATION WILL SERVE: O RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NuMBCROFLIVINGUNM,:_ NUMBER OF BEDROOMS: NUMBBR OF EMPLOYEE$: <br /> ❑ SEPTIC TANK TYPFIMrO CAPACITY Sal NOFCOMPARTMEMS <br /> ❑ GREASE TRAP TY MM CAPACITV Sol N OFCOMPARTMENTN <br /> ❑ PKG TX PLANT DIE'TwfICCro VCAR@p: WELL R FOUNDATION D PROPFRTY LINE R <br /> LI LIFT STATION Sm— TVPEOPPUMP ❑ SAND OIL SEPARATOR(ENCLoOTD BT <br /> SvnH) {' <br /> _ ry <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS NOFLWEE__ LENGTHOFLNE9 ft dW <br /> DwANCETONCAaLSr VEIL ft FOUNDATION ft PROPERTY LWE A L{ <br /> E3PILTERIHLD Weerx fl LENGTH ft DEPTH ft C <br /> DIETANCETON&ARDIT WELL B FOUNOAIKR'! ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPnt It <br /> DmTANLETONE.ANEW WELL ft FWNDATIOH R PROPERTYLNE R <br /> ❑ SUMPS wwnl ft LCNOTH ft Dom B <br /> DISTANC MNEAREET WELL--it FOUNDATION ft PROPERTY LOff R <br /> ❑ DISPOSAL PONDS WIDTH fl LENGTH ft DEPrH fl <br /> DIRTANCETONWREW WELL R FOUNDATION R PROMIYLNE R <br /> ❑ SE¢PAG¢PITS Names" Alma R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LWE ft <br /> I REVLON CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH NAN JOAQUIN rR)UNTY Ir' <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> �NIMUM2 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEA9f CILL`(2091953-]697 <br /> SIGNED T/ TITLE_ QAo/ .[�I's.�'1tOFb^" ATE <br /> I <br /> low <br /> I <br /> � n� i T4FfbJ <br /> a — x <br /> 'NYU <br /> TONT <br /> W � S <br /> 77gr <br /> L <br /> w <br /> ., .� <br /> ` vlv orau'"ar <br /> DEPARTMENT LY <br /> YIB Application Accepted By eieL DNT 1F os Area EDpwy�A IDN S9 4 6 ��4y <br /> FIRM lmpectlon By Dare J � ❑ SPECIAL PERMIT-AppmVM by <br /> Character oI Snll to Depth ora FC PIUSump Soil Character. <br /> COMMENTS <br /> PE SC Raed tal Imew Ampunt Pmeolr! <br /> Cath DBD B M Ramiftril Data Servir<Re uestp nvakeN Permit <br /> Yz•E.T., sir 4(02 3'7z.Dn I os ZG'r7� <br /> Qmm l ONSITE WASTEWATER PERMIT <br /> 12/JIR093 <br />