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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQU IN COUNTY'F.NVIRONMEA7AI 1 ILA imi DEPARTMENT 304 E YA'FRF R AYT-3-FL-STOCK rON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLF.PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUFD <br /> Jog.ADDREr-s 2.�S i-3 4.1e/_- _ CITYIZIP E S c 4 L v r <br /> CRO1 STREET /I 4o?OLn ! -_'_ _ AP'4 �-/IU ZZ PARC F.L SIZE ��2 "c .> <br /> OWNER NAME 1)U N //-,LVY _ _ _ -_ PHONE ' <br /> OWNERADDRLM _/L`I)-/?/)l(1 CITY'/STATE/ZIP G �j �yJ t�j <br /> CONTRACTOR I r I-- {J L— }�' hal IJ/'JA/�//' PHONE ?y/ SO lJ 7 <br /> CONTRACTOR ADDP.ESS - L3 �r _ _ Cli1'/ST.ATE1ZIP <br /> LICENSE U CA2 {1C-36 OTHER _ NUMBER EXPIRATION DATE_ .3 <br /> WATER TABLE DEPTH: D GFCN:RAPIIirAI.INFORMATION: Coordlnaln X y <br /> ❑ PFRC TEST N^ BI111,D1 Nf,PERMIT a _ LAND 115E APPLICATION/f _ <br /> TYPE OF WORK: ❑ NEW INSTALLATION RFPAIR/ADDfTIO ZI EYCINEr.R r.NF.D/ALTERNATIVE <br /> U REPLACEMENT _ � DESTRUCTION CIS--X) T%4tif�-- <br /> INSTALLATION WILL SERVE: ❑ RrsIDFNCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LfY1Nr UNITS: NUARLROF BLDR(A)MS: NUMBER OF EMPLOYEES: <br /> ./ SEPT IC TANKTT Pz:MFo_�y4!LZ'y rG' •> "�- CAPACITY d O _ ga: P Of COMPART'M Es r.9 <br /> U GREASE TRAP TY'PE.WrG CAPACI'rY gal #OFCOMPARD.IEh7S <br /> O PKC TX PLANT DIcrANCF TONE-,REST: WELL ft FOUNDATION Il PROPERTY LINE ft <br /> ❑ It-wr STATION Size TYPE OF PCM► ❑ SAND OIL SEPARATOR(ENCLOSFD SYSTEM) <br /> ;Y LF..ACH LINES ❑ LEACHINC CHAMBERS N of LINES LENGTH OF LINES O fl <br /> DISTANCE 1"O NEAREST wrl.l - ft FOUNDATIONR PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH _Il LENGTH _ fl LIEPIH_ fl <br /> Dis-re<ETONIEARM WELL ft FOLMDATION it PROPERTYLINE ft U1 <br /> ❑ MOUNDED WIDTH ft I-EVITH ft DEPIH <br /> ,.,,� DISTANCETONEAREST WELL A FOWOAiION R PROPERTY'LP,L fl <br /> Y JUMPS %%voTH I A LENrl" JL7 ti DF PTH I _ it <br /> DISTANC E TO N EARESI WELL So+- ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS N IDT" __fl 1 ENGTH R Deem+ R � <br /> DISTANCE Io NEAREST WEI I. Il f'OLNDATION rt PROPLRT'Y LINE ft m <br /> ❑ SEEPAGE PITS Nl'MaL■ _"10TH fl DEPTH_ fl <br /> D157ANCE TO NEAREST WTI.L h FOUNDATION fl PROPERTY LINE R 0 <br /> I HE:RE'HY CERTIFY THAT I HAVE.PREPARED THIS APPLICATION AND IHF.WORK WILL HE DONE IN ACCORDANC E.%I TH SAN JOAQUIN COUNTY <br /> ORDIVANCES,STATE LAWS AND RULES AND RF.!;Il1.ATIONS OFSAN JOAQUIN COUNTY" <br /> �- INIM"Um OUR ADVANCE N'O'I ICE REQUIRED FOR INSPECTIONS-PLEASE.CALL(7209)953-7697 p. <br /> SIGNED` 1 T,.F.___r1J0�S/,jIL DATE o / O <br /> I _ <br /> 9 <br /> I <br /> 1! AVr 41 <br /> Rc <br /> r <br /> N <br /> r01 feafill <br /> © A J A U1 C <br /> M <br /> M N <br /> 7/ <br /> DEPARTMENT I1•E(NLY� I <br /> .P Aicalion Acce{'led By 1'�.` Dale. 5� �L' ♦? Ary .Z I Employee W01 <br /> Fins)Inspection By _ Dale �� I] SPECIAL PERMIT-Approved by_ <br /> Chm"cler of Sall to Ih of P I/Sump Soil Character: <br /> COMMENTS � � d ti � .A fQ- (c4 (c4 <br /> _�di'2ti�ld <br /> 1 <br /> Ff 1E SC Rrcelved C'heckM Autouat Permitl <br /> Dale Iwnice p Permit IDM <br /> its, <br /> Code INFO B as Remitted S(•n4ee Request R <br /> S�—C- <br /> 4:-p21n11 ONSITE WASTEWATER PFRMIT <br />