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ONSITE WASTEWATER TRF TMENT SYSTEM PERMIT <br /> .,AN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3"°FL-STOCKTON CA 9$202 -(209)0 <br /> NON-REFUNDABLE..11PERMIT c ` `,. CALL(20B)W-769 FOR INSPECTIONS /yEXPIRES 1 YEA/RJ FROM DATE ISSUED <br /> JOBAUDRLSS �"I ZZ C„- l('L'\JS..yN�' CIrV/LIP {T C M1IVT c -I SLZ-o L <br /> CNIISR STPEF.T �(J Ck— APN l�Cr - 334a -O� a <br /> PAHC'ELSIZE�00 IAC c <br /> OWNER NAME S; LS <br /> CI E VS( �/ <br /> G,;�,/-1 i/`4 PHONE 3(Q - 11*:[Z;.1fi <br /> OWNHRADDRE&S _ I\& C. II One'YS �"'A/�. CuWSTA'O%ZIP rT�D Sr15 (11Z�-c) <br /> 7 f <br /> TDNFRAITOR hP(�� cel. A-,, , Cl- -rp �1,5,(C,C ��c PnonE_ ?�&;: -/j3 m- <br /> CONTRACTOR ADDRESS /V C, I✓C(�S-ii- .IL W JC.U\ CITY/STATFIZIP U Al , CIES CI G-fc) <br /> LICENSE ❑C42 13 C-36 (ITIIER NIIMBF.R EXPIRATIONDATE <br /> WATER'1ARIL'.Ill:l'l U: Il (:HIR:RAI'1111'AI.INFIINAIAIIIIN: (414 11,111ex X y_ <br /> PERC ITS (.N) NIIMUFR 1 '1- I ALL Um A,r l lr AnDNR PPE-Q'}'�SI <br /> TYPE OF WORK: U Nmir.11ALLAnnN ❑ REPADVAuumuN U ENGINEm DESIGNED/ALTERNATIVE <br /> ❑ RvINA(EME.NT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDE.N('E ❑ COMMERCIAL ❑ OTHER 1 <br /> NUMBER OF LIVING UNH IS: NUMRER UP Ilwoko IMS: <br /> NUMBER OF EMPLOYEES• <br /> ❑ SEPTIC TANK TYPE/Mm CAPACOY SRI R OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gel R OF COMPARTMENTS <br /> ❑ PKC TX PLANT DM. ANCETONEARFST: WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ LIFTSTATION SIZE. TYPEOPNIM, ❑ SANDOIL SEPARATOR(ENCLOSED SYRTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS R OF LINES LENGTH OF LINES 11 <br /> DISTANCE to NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ FILTER RED WOVID N LENGTH R ' DEPTH R <br /> DISTANCF.TONEARTST WELL 11 FOUNDATION R PROPERTYLINE R t <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH R N <br /> DISTANCE TO NEARFSE WELL R FOUNDATION Il PROPERTY UNE 0 (J <br /> ❑ sumps WIDTH R LENGTH R DEPTH R <br /> DISTANCETONEAREST WELL R FOUNDATION R PROPERTY LINE 0 rIl <br /> ❑ DISPOSAL PONDS Wo r i R LCNGTI R DEPTH IF <br /> DISTANCETONEAREST WELL R FOUNDATION 0 PROPERTY LINE 0 U <br /> ❑ SEEPAGE PITS WIDTH R LENGTH R DEPTH R b <br /> DISTANCETONEAREST WELL 0 FOUNDATION n PROPERTY LINE -R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL RE DONE IN ACCORDANCE WITH SAN JOAQUIN MONTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> IMUM I4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PALEEAfSEE CALL(2W)053-7M7 <br /> SIGN TITLE /J��Q�P DATE /YA <br /> OPT <br /> "illll.h `A/j 1Nn'•�/ N`!II a•(I/ <br /> o�tl <br /> ,.1•Ft:fT Ib)tP 2t.iT ,b€tr 10tPtT AYME <br /> rT- <br /> RECEIV- <br /> i <br /> ///�/ DEPARTMEgNT S NLY SAN JOA WN PJII' <br /> APDII<Mbn Acce ABY -11.C'GL_ pale / �� G Arca 1 2 EmpIOY� VIR hT`�7TJ/J� <br /> pinN loWn Mn y Dnle XI`i_ 13 SPECIAL PERMIT-Approved by raOE�R MEM/�g <br /> Cbmder 015011 pjRDf3F1 PIUSump Soil CharR<ler: <br /> COMMENTS <br />�'% LTJ - �' �/• /--� � -�s�a.7 <br /> PE Sc Revived Che< ' Am0un1 D01e Pc mill IDVO22B PermLl IDq <br /> Code INFO B B RcmRted Service Re DeM R <br /> j zz S2 p .IbS-L.0 <br /> eIJ1I-B01 ONSITE WASTEWATER PERMIT <br /> L•m <br />