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ONSITE WASTEWATER 1 HFA NIENT SYSTEM PERMIT <br /> %$AN JOAOUIN COUNTY ENVIRONMENTAL HEA;I II D1 PARTMENT l86a E.HAZELION AVLNIIf-Sr0CKtON CA 95205•(2G9)46a•3420 <br /> NON-REFUNDABLE PERMIT _ CALL 209 953-7697FOR IMSPLC_iIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB AuDHESS f Y-^7 CITY/ZIP It-At) L VI <br /> /1 e A ^� M <br /> CR0%S STRrITT _11'1 u f r _^�/(�L�`,,Z� /� APN !� ( •�� '�ry _ _(.PARCEL SME •� c <br /> OWNER NAGE �{d 1 /`�',A�y1.� � C ryy�•�, �- 7 r2 PQHONE {/a.� <br /> OWNFR ADORFSS he 3,,-3 Lg /Ou%�, A.'e i► CIIYI%TATF/ZIP(,�g�Iv-Al e- j___ <br /> CONtFIAC1OH M,��^ItS ,1/�7wu sc, _ Lei PL10NE `5Y_ r`D—y`&-1 ' S . <br /> CONTRACTOR ADDRESS pO 6 PJY G rb_ CITY/StATE/ZIP ilm—r.�I'/s�•-/4 44 <br /> LICENSE C-42 I //C--36 (O�TTH(EER___ _ NUIMER y�7ENPIRATIONDATE <br /> WATER TABLE DEPTH:3V. L `� IT GEOGRAPHICAL INFORMAI{ON: 1 CODr X _ Y <br /> PERC TEST s I BUILDING PERMIT M ��1W •VIND USE APPLICATION N 1 <br /> TYPE OF WORK: NEW INSTALLATION 1'AIIIIA aIhI II IN ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OIII-OF-SERVICE SEP71CSYSTEM DESTRUCIION <br /> INSTALLATION WILL SERVE: I Ri-smNCE COMMERCIAL ✓IHkH S �_ ^•t <br /> NuuKat of LrvING UNITS: _ NUM OF BE DROOMS:_ _ NtHAHFH Of E EPL oYFFS: <br /> �EPTIC TANK Tr-,I MFG 0/1 rZ._____ CAPAct1Y I� 'J.II I uF COM-ARTMENTS2— <br /> ❑ GREASE TRAP 1�'I+MFG CAPAO qW M ETF COMPARTMENTS <br /> c� <br /> DISHANCF TO NTA{ll 51 :^il I, *5/7 N FuUNllull KaV �� R PaOPfRTY t INE.}>• �-J It <br /> U LIFT STATION SIZL IYPFOFPUMP O PKGTXPLANT U SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING_CHAMt1FHS Iclr•LINES- IL-NGTHOF LINES _ h <br /> DISTANZj�j�1`11 yyCIL FWr h PROPERTY LINEh�ILTER BED WIDTII IDIS l n t.EtKirH n 01 PTN (9 h nDrSTAN 11,7 .IFIL 1 1fnATeTN ��f it PROPERTY LINE. <br /> ❑ MOUNDED WIDTH it LmTH_ -__ h Ik'PT11 h <br /> DISTANCE To NEAnEST WELL . - IT HX*9)AIION_ n PROPERTY LINE - It <br /> ❑ SUMPS WIDTH _R LENGTH It DEPTH <br /> DISTANCE To NEAREST WELL it FOt*OATION _ n PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIo1H It LENGTH _ h DEPTH _ _ it <br /> DIS 1 ANCF.TO NEAREST Wrl I II I.y INOAI'M it PROPERTY LINE_ ft <br /> ❑ SEEPAGE PITS NUNDEA __ _ WIDTH _ fl Dlrnl _ __ _. __ IT <br /> DISTANCETONEAREST WFLI _ It .MWDATKx. RTY LINE N <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND 11r1AT THE WORK WILL BL DONE IN ACCORDANCE WITH SAN <br /> JOAUUIN COUNTY ORDINANCES. STA1L LAWS, AND RULESAIID IiEGDLAlILINS. 1 Ai SO CFRTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORpRS S7Al <br /> IA CONTRACTOfl LICFN';L BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> lNIMUM 24 HOUR.A VANCE NOTICE REQ IRFO I QFi INSPECTIONS-PLEASE CALL(209).99553-7697 <br /> SIGNED _ -`�_•- - - 7171E C°J n•�t 6'�.Q r _ DATE <br /> 0 <br /> -44 <br /> TT <br /> DEPART <br /> XTUSEDAILY <br /> Application Accepted 8 DaleIS�up <br /> . 7_ Area t0l_ Empbyee IDN S <br /> Final Inspection By _i �DlltsA SPECULPERMIT-Approved by <br /> Character of Soil to Ficplh of 3� - Soil Cn+Lcret.� --y�� <br /> COMMENTS � <br /> Iv41`,l &d <br /> PE SC Received Checks/ Amount PeFF" r <br /> to Invoices wrmn IDs <br /> Cfidf INFO BY Ceeb Rerrrllted Service Amu e <br /> 1 ? S4 1 <br /> � <br /> 42-01 (INSIIF WASTEWATER TR161147 SYSTEM PERMIT <br /> ti1N1) <br />