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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 31W E WEBER AYE-3-Ft-STocxToN CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT (� CAL[,(209)953-7697 FOR I NSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> OB ADDRESS _LRLN 1DPR.LR'v�f. En_y�_,__�y� C�IITYFLIP �"�-f^�(f ^/ CTg5LIZ _ <br /> CROSS STREET � E v>7'T '�� APN D8-G`JI.-O-(Z PARCELSIZE Z-0 I%r-ra <br /> OWNER NAME J--11 -�C EI .�- i.tA 1Jl _ PHONF__- un <br /> OWNER ADDFVMS 4 CITYISTATEJLIP___- _``_ <br /> CovIRAtTOR <br /> CONTRA(".TOR ADDRESS ( l ►J a Pc'fl -Y- CfTYISTATUZIP <br /> LICENSr 13Z42 0C-36 01 HLRNUMBER 7 �_ EXPIRATION DATE_ OS <br /> WATE.RTABLEDEPTH: _ It GE(R;RAPHICALINFORMAT(ON Coordinates X------ Y <br /> TE <br /> C] PERC' ST #_T�4 BUILDING PERMIT# [' --07601/O;'-[_[.AND USF,APPLICATION#_______ <br /> TYPE.OFWORK; NEw INSTALLATION ❑ RFPAIPJADDITIONI ❑ ENGINEERDESIC.NED/ALTERNA'r1YE <br /> ❑ RL.PLACFMFN-r _ ❑ DFSTRUCTIO% <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL. ❑ OTHER_ <br /> NLMBFR OF Liyix,.LNITS;__ NUMBER OF BEDROOMS: NUNI8Fr OFEMPLOYEES: <br /> SEPTIC TANK 1'YPr!MPG�RQ-�CI'<'r�T }� L CAPAcrry ;e #Or COMPARTMENTS <br /> �- <br /> ❑ CREASE TRAP TYPE,`MFO _ — CAPACITY_ `__ _ gal #Of COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL Sb r ft FOUNDATION_ 11=1)' Y R PROPERTY LINE <br /> O LIFT STATION Sac TYPE OF PUMP_ ❑ SAND ilIL SEPARATOR(ENCLOrSSEED SYSTEM) <br /> U LEACH LINES M-LEACHINGCHANIBERSI�a-3(O Y-- 7-0 #nrLINES LENGfHOFLtnE& <br /> r <br /> DISTANCE,TO NF,„(REST W1'LL�00 ft F'OCNDATION-��C -ft PROPERTY LINO -R ,J <br /> o Fu;TER HED WID'1"H_ —_ __ft LENGTH _- �- _ft DEPTH <br /> DISTANCETO NEAREST WELL_ _fl FOUNDATION R PROPERTY LINE <br /> ❑ MOUNDED WIDTH` ft U11GTH R DEPTH ft <br /> DISTANCE TONEAREST WELL,i R FOUNDATION _ R PROPERTY LINE ft <br /> Q SUMPS WIDTH__ _ft LENcfH _ _ R DEPTH ___ <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION ft PROPERTY LINE _ _ _ R <br /> U DISPOSAL PONDS WIDTH ft LENGTH _ Il DEPTII <br /> ��( DISTANCE TO NEAREST WELL__ E FOU.-MATION R PROPERTY LINE__ _ft <br /> ii SEEPAGE.PITS NTIMBRR__� WIDTH_ O +f '1k DEPTH <br /> �y r <br /> DISTANCE TO NEAREST WELL ..>V 'f" ft F-IUND AiION Cj�r F[ PROPERTY LINE� It <br /> C <br /> 1 HEREBY CERTI FY THAT 1 HAVE PREPARED"CHIS APPLIC.A TION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQU IN COC N'TY <br /> ORDINANCES,STATE LAWS.AND RULES,AND REGULATIONS OF SAN JOAQUIN COC N-TY. <br /> MINIM )M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPEC--IONS-PLEASE CALL(209)953-7697 <br /> SIGNED _ -�^l�~ TITI,E;__�n-[�'1''c'� l~�t2 DATE <br /> t <br /> I <br /> ? f <br /> I i !Eu <br /> I I <br /> 1 <br /> At,J Fad <br /> Fyn( MENT <br /> 1 J <br /> #P <br /> I <br /> 11 i <br /> + o <br /> N <br /> - <br /> J <br /> p 'L DEPARTMENT USE ONLY'[ L� <br /> 'Application Aceepte _ - ^ Date /L ZY C -7_ - A. Employee IIT',' '�� <br /> Final 1-pcction r Date �"�y"��n y'Y- _ ❑ SPECIAL PERMIT-Approved by- <br /> CharactcrofSnill <br /> PR/Sump Soil Cho racter: <br /> COMNIEN'I'S ti'Ew -p7To F <br /> PL SC RecelvrJ Anmunt Dat erm,t vulce# PermHID# <br /> _Code INFO Cash Remilled Service Reguest# <br /> I z-r3 117 <br /> 42-02-001 ` ONSITE.WASTEWATER PERMIT <br />