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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SANJOAQi;1RCOUNTY EN%IRONMENTAL HEALTH DEPARTMENT 304 E NN F.BER AVE -3'"FL-STO(KTON CA952,92- f2t))468-3420 <br /> NON-REFUNDABLE PERMIT GALL(209)953-7697 FOR INSPE("TIONti EXPIRES 1 YEAR <br /> - F40M DATE ISSUED <br /> JOBA ERESS 33 CITY/ZIP <br /> 3 e C - , C�.J'I / S ` 2--Z- <br /> CROSS <br /> =i <br /> / ( / <br /> CROSS STREET APN��c ]- `'^ 3[7 PARCEL SIZE C� l�' c <br /> OWNERNAME {1� C ..'�' Y 1 PHONE i/C C' y <br /> OWNER ADDRESS 33-5 E /^ { - CITY/STATFJZIP <br /> CONTRACTOR ` c;M0,C <br /> CONTRACTOR ADDRESS CRY/STATE/ZIP ��J <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: 1717 i'- It GEOGRAPHICAL INFORMATION: CooTdinate3 X y <br /> ❑ PTEST(S) NUMBER LAND USE APPLICATION M <br /> TYPE OOF F WORK: '�T,IST,[LZ•ATTON ❑ REPAIRIADDRION ,y ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ <br /> REPLACEMENT C3 DESTRUCTION <br /> INSTALLATION WILL SERVE: Id RESIDENCE ❑ COMMERCIAL ❑ OTHER (� <br /> NUMBER OF LIVING UNITS: NUMBER.OF BEDROOMS: Ia NUMBEROFEMPLOYEFS: 1 <br /> SEPTICTANK TYPE/MFG 5y( Z�-}-/ /y{ c- CAPACITY /Z1� 881 #OFCOMPARTMENTS _ <br /> ❑ GREASE TRAP TYPE/MFG CAPACRV <br /> gal It OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION 11 PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED Srsrem) <br /> LEACH LINES ❑ L N OF LINES _ LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ FILTER BED WIDTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION fl PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE ft <br /> O SUMPS WIDTH ft LENGTH fl DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH tt <br /> DISTANCE TON RUST WELL ft FOUNDATION_ft PROPERTY LINE ft <br /> SEEPAGE PITS WIDTH 03 P 5 fl LENGTH R DEPTH ?�/ IN <br /> DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(?091953-7697 <br /> / <br /> SIGNED 1� TITLE CJI✓ )7'� F' DATE l — Z 2��. <br /> F <br /> I <br /> o ma au .vK <br /> Mi <br /> vmm� rmm� __mm�_ iM.w <br /> r- -`--- lam' SAN - <br /> T[T <br /> Hvxa.nm-a 1 PUB . <br /> Fq <br /> ENVIflBK^a!' `IVI <br /> 1 I _ <br /> 1 <br /> 1 � <br /> .m awv� 1 eaR <br /> ________________________ _________� . <br /> i 1 <br /> 1 �a.rr•wear,..® I <br /> 1 _ <br />