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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT iCIEZD <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WPEERAVE-3"'FL-STOCKION CA 95202 -(209)448-3420 <br /> NON-REPUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIOm EXPIRES I YEAR FROM DATE ISSUED <br /> L�mAwmm I 11YY C C�-ffvZP .4GptWf-JIREEE LTQnAPNQQI- IIQ— IQ` , ��11PHONE <br /> ADOREE4 Il, N - ` LGA(iAt'.S R4 CITYMEATEIEPCFOR 1_, L� r 'L.{ �LG^ PHONE(. ADZUH <br /> CmISTwTU21P <br /> WCENSE LJ C42 OC-36 OTHER NummitCG <br /> Exnq,AnOn DATE_ <br /> wAl'1/ITALLCDEIEM:_ (1 GEIX.RwPHICALINFORMArpN: Cpl4lpin .0 Y —J <br /> ❑ PERC TPST(S) NUMREI! LAND UK APPLICATION W Q <br /> O <br /> T PEOPWORK: ❑ NEW INSTALLATION REPAIIUADDITION ❑ EnunLER DEEIGHED/ALTERNAnvE d <br /> O REPIwCEM[NT ❑ DESTRUCTION <br /> INSTALLATION VA LSERVE: ResmenCE ❑ COMMERCIAL ❑ OTHER_ <br /> NUMLR OP LIVING UNITS: NUMBER OY BEDROOMS: NUMBEROPEM V E3: <br /> ❑ SEPTIC TANK TYPEJMFG CAPACITY <br /> pil #01COMPARTMENTS <br /> ❑ GREASE TRAP TYPFIMm CAPAcrry gal ROr COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TONEAREST: WELL. B FOUNDATION fl PROPERTY LINE R <br /> '�O\\\LIFT STATION Slu TVPROFPUMP ❑ SSANOOILSEPARATOR(ENrlAH DSYEPEM) <br /> q LEACH LINES (3LEACHING CHAMBERS ROFLINFR ` LENGTH OF LMES ICIt� B <br /> DISTANCE TO NEAT WELL LTY1-�O B FOUNDATION ft PROPERTY UNG ft <br /> ❑ FILTER BBD Wllm D LENUTH 4 DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION—ft PROPERTY LINE B <br /> ❑ MOUNDED WLDIB A LENGnI B DEPTH ft <br /> DIVAr10El'ONEARSST WELL_ B FDUNDATgN ft PROPERTY LINE ft <br /> ❑ SUMPS WIDrx A LENLTH _ft DEPTH ft <br /> DLSTANCETONEAREST WELL _ft FDQNUATIOV- N PROPERTY LME R <br /> ❑ DISPOSALPONDS WIDTH D LENUTN ft DEPIN R <br /> p ANCLTONEAB[8'F WELL ft FOUNDATION n PROPERTY UNE ft <br /> p[" SEEPAGE PITS WwTN IkZ I R LENGTH --fl DEPTH Zy—ft <br /> ` \ DIWAn TONEARCS'r WELL IS ft FOUNDATION H PROPFRTYUNE ft <br /> IHERE YCERTIPY THAT 1:PREPARED HIS APPIACATION ANOTHE WORK WILLIE DONE M ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> /SPATE LAWS AND RULES AND REGULATMNS OF SAN JOAQUIN COUNTY. <br /> RR1M L HOUR ADVANCE NOTICE S EQUIRED MR INWE"NOWS;-PLEASE CALL(209)053-7441 <br /> SIGNED TITLE DATE <br /> 7-1 Nil boo- <br /> Pi <br /> IVET <br /> NT H. <br /> if <br /> a <br /> Z <br /> DEPA IFI,,lE <br /> SE ONLY -! <br /> ApplkNion Avve tea6 Del. 5-22-0) A. 'Ll L EmPIoYw IDD_ ,/5 64 <br /> HAW lmlowk. I D.I.J'/x/03 13 SPECI�&PERMIT-AW.m Iml nY <br /> CMrulr of soil Lr DepDI 3 FU THISump Soil Charmer: <br /> COMMENTS 1Q� <br /> PE SC RerNYell Der wmpool Date PernriU IDvWcrp PerMrIDY <br /> COM Imm B R ReMtled Servke R <br /> 11 IIS I c 8 3 - <br /> O-0I-0UI <br /> IN ONSITE WASTEWATER PERMIT <br />