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ONSITEWASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONIAENTAL HEALTH DEPARTMENT 1068E.HAZEEL70N At7-:IJUC-STOCKTON CA 95205-(209}468-3420 <br /> NON-RFFUNDAELF�P'7ERMIT' CALL(209) .953-7697 FOR INSPECTIONS / EXPIRES 1 YEAR FROM DATE ISSUED <br /> J06.ADDRESL �7 / "/ ��/� 'T ` C1-„Y!1ZIP�� / :�.� 1 f <br /> CI.OSG STREET APN <br /> OvrNfR NA>SC <br /> �L&ALt[LtiJ l! 1 v V "+A PI ov- <br /> OWNER ADDRLSS _ CI TY.!STATErZIf <br /> = <br /> G= ` 7� - <br /> �c-�' I•C <br /> CONTRACTOR �-f/' i� .:� •{' PHONE <br /> / _ _c <br /> CGNTRAC'CR ADDRESS ! e/�• I �'/: ��:: l_�� cJ:�+ lTYrsT;.TCI7JP <br /> LICENSE C-42 i i[IC-36 OTHER 14NUMEERD-Z-Z�-a-EXPIRATION DATE <br /> WATFR TABLE DEPTH: fl GEOGRAPHICAL INFORMATION: COOfd11 at”. X / / Y <br /> -- <br /> r I PERE TEST � BUILDING PERMIT4, LAND USE A?PLJCATION# <br /> TYPE OF WORK: 1 NEW INS IALLATION R=_PAIR+ADDIIIOFI _ ENGINEER DESIGNED iAL-ER".' <br /> (d REPI.ACF.I.5r%T TN f, Ot1T-0=-SER'vICESE-QTICSYSTaw 40 D=_STRJCTION <br /> INSTALLATION WILL SERVE: 12 RESIDEA,CE 1 CC'MVLRCIAL / r OTHER <br /> y Nu MBER OF LIVING UNITS: NUMBER OF BEDRC•OU.S: �/ - NL%gBER OF EIAPLOYEES: <br /> �� 7 <br /> is ,F-P TIC T�'NY TYPE!MFG �L!� z ��e GAFAC"r I L-; <br /> gal #OFCOA1PfATaiENTS <br /> b E� <br /> ❑ CREASE TRAP 1YPErMFG CAPACI-Y gal #OFCOMPARTIVEN-S <br /> DISTANCE TO NEAREST: Ii01 t FOUNDA?I•ON ft PROPERTYLIN= ft <br /> CI LIFT STATION SIZE TYPE OF PUNJP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR;ENCLOSED SYSTEM) <br /> C LEACH!_INES - LEACHING CHAMBERS #OF LINES LENGTH OF LINES R <br /> DISTANCE TO NEAREST t'.EL- ft FOUNDATION ft DROPERTY LINE ft . <br /> = FILTER DED WID-r+ it LENGTH ft DEPTH it <br /> DISTANCE-0 NEAREST WELL it FOV:MATION R PROPERTY LINE ft <br /> J G:0 UN DED WILT+'. _ R LENGTH ft DEPTH fi <br /> DISTANCE TO NEARES- *FLI_ ft FOUNDA'ION H PROPERTY UNE _ it <br /> SU'rA?S WIDTH_ II LE\GTH H DE-TH ft <br /> DISTANCE T'ONEARES' -hat- fl 'OUNDATDN R PROPERTYLINZ R <br /> C DISPOSALPONDS WIDTH R LENGTH it DEP'H _ Q <br /> DISTANCE-TO NEAREST or.LL R =OUNDATION it PROPERTY UNE R <br /> C SEEPAGE PITS NUTABER tNln-H R CGFT R <br /> DISTANCE TO NEAREST '.'SEL- It FOUNDATION (, PROPERTY I INF ft <br /> 1 IL3EDY CERTI�= CHAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> SATE LAWS AND RULES AND REGULATIONS OF^SAN JOAQUIN COUNTY. <br /> MINIMUM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL 209 953-7697 <br /> SIGNED �.' , �- TiTLE�� �T r DATE `/'3 i/ <br /> �I-4 <br /> t <br /> tr <br /> i <br /> f� <br /> ,1 <br /> A la C U <br />