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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBERAYE-3"FL-STOCKTON CA 95202 -(2051) H3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB.ADDRES9 10Wi,.Imbf brayt td. CITY/ZIP Mptly'/ 95694 <br /> CROSS STREET 1 - Ir APN 001" ofW-6,2PARCELSITL <br /> OWN ER NAME TOORi <br /> nM1Y MPxonCmoi/ <br /> OWNER ADDRESS /a93J W- W4 JAIUI• C-t-`V- t Cm/STATNPAP 774PJ- CA ?Sited- <br /> --CONTRACTOR :N P4K. PHONE YG- O t_ <br /> COMTMCTORADDRESS 37341 iee Ab+E-j IV, CDY/STATE2IP P< S-2� <br /> LICTT'SE <br /> 13 C-2 3WC36 OTHER NUMBER 1 L EXP¢IATIONDATL=q <br /> WATERTABLLDETI:_ R GEOGRAPHICAL INFORMATION: CORMleet. % Y <br /> ❑ PERC TEST Y BUILDING PERMIT# LAND USE APPLICATION <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADDITION O ENDmEm1FniGNEO/ALTCRNATIYE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: REB.— ❑ COMMERCIAL ❑ OTHER- <br /> NUMBER OFLIVING UNITS:_ NUMBEROFBEDROOMS: NUMBRROFEMPIOYEEB: <br /> ❑ SEPTICTANK TYPEYMFG CAPACITY Sal O OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPPIMFG CAPACITY p1 KoPCoMPARTMENs <br /> ❑ PKG TX PLANT DISTANCETONLAREST: WELL R FOUNDATIOM1' It PROPERTY LME R 0 <br /> ❑ LIFT STATION Sim TYPLOP PUMP ❑ SAND OIL SEPARATOR(EXCLOBED SYSTEM) <br /> �I LEACH LINES ❑ LEACHINGCHAMBERS HOPLMESLEHOTHOFIJNE9 X00 It <br /> DISTANCETONEAREST W LL J00 'I— R FOUNDATION 20 R PROPERTY LINE /0 fl <br /> ❑ FILTER BED WIDTH R LENGTH fl DEPTH R n <br /> DISTANCETONFAREST WELL ft FOUNDATION R PROPERTY LME fl rV <br /> ❑ MOUNDED WIDTH R LENGTH _ft DEPTH ft \,3y <br /> DISTANCETONEAREST WELL ft FOUNDATION_ ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft LENGTH A DEPTH R <br /> DISTANCE TO N EAREST WELL _fl FOUNDATION R FROPERTYLOIE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH R <br /> DISTANCETONEAREST WELL fl FOUNDATION_ft PROPERTYLDIE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH fl DEPTH R <br /> DISTANCETO NEAREST WELL ft FOUNDATION R PROPERTY LME It ` <br /> I HEREBY CERTI PY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDI NANCFS.STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. {. <br /> y1NI�M U,DM,74(y�OU,RA/DV�NCC NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 c!S <br /> SIGNED ViT-/� TITLES TJO DATE /- jf6-V.� <br /> I <br /> 05 <br /> w <br /> DEPwRTMENT PSE qNLY <br /> Appil.fi tAaMpWB DRH f 18 AS Am 'ZI EmployalDH 536 <br /> Final lnFpeeebH DAIe OS ❑ SPECIAL PERMIT-App--d by <br /> Cheeeter of SDI IR Dept 3 Ft: Pi"ump Soil Chmeler. <br /> COMMENTS �0 .-f <br /> .Pd A)'Ew LEAcs4 ..... u != <br /> PF. SC R—IYed Ch Aenent Dale Permit/ IemleeY PerMIt IDM <br /> Gude Ixro B BFB R.Ink d sen*,Roiliest B <br /> 1142.,t) Iis 0^ /S'o.o0 1 <br />