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�1 <br /> ONSITE vZASTJF,WATER TREATMENT SYSTEM 1-c,RMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 301 E WEBER AVE-3"FL-STMKTON CA 95202-(209)4WU20 <br /> NON-REFUNDABLEPERMIT CALL 2 953-7697 FOR Imspu m% UPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDREss CrIYl2dP �, <br /> CROSS STREET APN-111 .10 <br /> PARCEL$ILL <br /> OWNER NAME /" HO <br /> PNE (� <br /> OWNER ADDR M - Crr1MATFM1P ✓ Ct <br /> A <br /> CONTRACTOR ^4T � <br /> PRONE <br /> CONTRACI'ORARDRE85WCU� CTtY!&TATTIZIP <br /> LICENSE [3 C42 C-36 OTHER . NUMBER EXPIRATON PATE <br /> WATER TABLE DerrR: R GEOGRAPHICAL IN stet X y <br /> O PERC TEST # BUILDING PERMIT# - LAND USE APPLICATf4N# <br /> TYPE OF WORK: ❑ NEW INSTALLATION a REPAl1UADIRT1oN 11 EmmEER DESIGNED/ALTERNATIVE <br /> ❑ REPtACEMENT l7 DEFrRU('TIoN <br /> INSTALLATION WILL SERVE: ❑ RPSIDENCK COMMERCIAL ❑ OTHER <br /> NUMBER OF LIvING UNITS: NUMBER OP BEDROOM& NUMBER OF EMp1.OYF.ES: <br /> SEPTIC TANK TrPERJIPc�C� � CAPActry�— 931 #OTCOMPARTMF.NTS <br /> O GREASE TRAP TYPFlMFG CAPACITYppl #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DIS•TANCETO NEAREST: WELL— R FOUNDATION R PROPERTY LME R <br /> ❑ LIFT STATION Slzr. TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES O LEACHING CHAMBERS #OF LINES � LJ:NGTH OP L.1NEs :/'� R n <br /> DisrANCE Tri NKARTS }T WELL `R FOUNDATION I� ft PROPERTY LINE 'C� R <br /> Ll FILTER BED WIDTH ft LENGTH R Drrr" <br /> DIsrANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH A DEPTH R <br /> DISTANCETO NEAREST WELL_, ft FOUNDATION fl PROPERTY LME R <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE REST WELL ft FOUNDATION ft PROPER LINE, -•_.• _ft <br /> SEEPAGE PITS NuMBER�WIDTH`�! ft DEPTH ft <br /> DISTANCE TO NLAREST WELL�.T�]t FOO NbATION7a�'J R PROPERTY LINE fl <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION ANDTHE WORK WILL BE HONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> O ENANCF-%STATE LAWSAND RULES AND REGULATIONSOFSAN JOAQUIN COUNTY. <br /> �11� \1U iHht� Il\\N('►'%�l'[!(T.RF:QtYRFa1FOR I IUNS-PLEASF;(-AIJ.{JM)4il-7h97 <br /> SIGNED TITLE DATE Os-+ <br /> _4�"•_ If newer wvasnuee j��71 <br /> fi <br /> yr l - - t, <br /> g <br /> �--f <br /> . r <br /> DEPARTME-41 lyfiE %iLV <br /> katNaa <br /> ApplAaapted Date t:Br.' '.- A"a _. �FmplID# <br /> sp <br /> Final Inspection BY Dale l SLD�G O SPECIAL PERMIT-ApprDvM by <br /> Character at Soll to pth of 3 FI; Pit/Sump Soil Character. <br /> COMMENTS 1,ov' <br /> _ t• <br /> —J9iiy(I �xa�..-�A..Jlf <br /> „f(T.rl <br /> PE SC Reedved Cberk#/ Amouat A� Peradtl <br /> I Code INFO B Cash Readflun ServkeR ert# InYaire# Permtl[DM <br /> SUn I4 ,� f1�J <br /> Sa <br /> 42-02-001 <br /> 12r22li0D3 ONSITE WASTEWATER PERMIT <br />