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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3a'PL-STOCKTON CA 95102 -0")A6B 20 <br /> NON-REFUNDABLE PERMIT CALL(209)95 -7697 FOR INSPECTIONS XPIRES YEAR FROM DATE ISSUED <br /> JOBADDRESS 11=5y!. ^�CYTY21P <br /> CROSS STREET APN ' •� .J-3a-.o -G Y PARCEL SIZE <br /> OWNER NAME l_�V � PHONE <br /> y OWNERADDRESS �A � �y-/ �� CmmrATVEIP <br /> CONTRACTOR ✓yo9/(� PHONE �l JT `J`�J <br /> CONTRACTORADDRE /I /.c.?s��•IfNK CITY/STATPJZIP <br /> LICENSE 2 ❑C-36 OTHER NUMBER u EXPIRATION DATE O�0 ` I <br /> WATER TALE DEPTH: X619 ft GEOGRAPKIGLINPORMATION: CoorOlnaMc X V V <br /> ❑ FERC TEST(5) NUMBER LAND USE APPLICATIONp Q <br /> TYPE OP WORK: NEW INSTALLATION ❑ REPAIWAODMON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION P� <br /> INSTALLATION WILL SERVE: IMIRESIDENCE ❑ COMMERCIAL ❑ OTHER 1111 <br /> NUMBER Of LIVING VNflS: /�� �� NL'MMXOPBEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK MF1MFG l_81'I<i CAPACITY/ O 20 MOFCOMPARTMENTS <br /> /❑ GREASE TRAP I FDWIFG CAPACITY PI NOFCOMPARTMEHTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL Icer ft FOUNDATKIN�-"J!I B PROPE0.TT LINER <br /> ❑ LIFT STATION ...,,,SSize TYPEOFPuMP ❑ SANDOILSEPARATOR(ENCLOSEEDSVITIM) <br /> / <br /> ❑ LEACH LINES MfLEACRINCCRAMBERS l�J LLh. #WLwPS LENGTH OE LINES T D It <br /> DISTANCETONEAREST WELL��. ft RDUNDATION CO It PROPERTYLVOi 5'e ft <br /> ❑ FILTER BED WIDTH R UNGTH ft DEPTH R <br /> DISTANCETONEAREST WELL ft FOUNDATION B PROPERTY LINE B <br /> ❑ MOUNDED WIDTH ft LENGTH ft MITN B <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft LBNDTii ft DEPTH ft <br /> DISTANCE TONER E WELL ft TOIINDATKKI ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft L om R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY IJNE It <br /> •�CAEEPAGE PITS WIDTH 2-,(o" R LENGTH ft DEPTH As J R <br /> (( DISTANCETONEAREST WELL /SC It FOUNDATION /0 R PROPERTY LINE L R <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARPA 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 /> IHIM UM HOUR NOTTCEREQUIREDFORINSME�IONS-PLEASECALL(2N)953-7697ell <br /> 99 <br /> SIGNED TITLE DATE <br /> —� <br /> 43 <br /> 'AIIA' <br /> 3 <br /> 3 <br /> 9' <br /> I. <br /> r <br /> 1 <br /> _ I <br /> A AaapW _ EDaP DEMO F AT® /l EmPbym IDk <br /> FIOd N. MIND Daft //- � LlSPECIAL <br /> IoRMIT-AppNWadby <br /> ChOr«ftrDISOBWDe ,f3R: Pid HIS Soil Char«Irr: <br /> COMMENTS &i gzy k .o 4G&J I i.,y I <br /> s r <br /> PE SC RecelveA Ch«MI AIMOnI 0.M PerWU 1,HMHMk Perndt lDlt <br /> s COAs INPo uh Rea1HW ServiceRupwatR <br /> 7-7 II i a3 (e <br /> 42-01-001 ONSITE WASTEWATER PERMIT <br /> ILM13 <br />