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ONSITE WASTEWATER TREATMENT SYSTEM PERMI���N�� <br /> SANJOAQUIt COUNTY ENVIRONMENTAL HEALTH DEPAR•PNIZNY <br /> NON-REF(}NDABLEPERMIT 30aEWEBERAVE_ga4pL sirocu'roNCA95202-(209)468-3420 <br /> p� f ,� CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE.IsSu£D <br /> �� JOB ADDRESS ' W5151-,41 AIA F&O-AD - <br /> CtTYYGIP R <br /> cRosss7RE -&4r-4,e qA & PA- APN <br /> PARCEL SIZE . 9 <br /> OWNER NAMQ l31 7 P �tA!/� J2J17ST�` +� © S <br /> 4 PHONE 033" I,Y4S_ <br /> OWNERADDR! 033-0 WX$r yjA/AJF ROAD <br /> �S <br /> CirvtsTATerbp Ti2.4G/ 953 rtd <br /> �' Gd�lLtc r i�� —r <br /> I <br /> CONTRACTORi <br /> CONTRACTOR ADDRESS di <br /> � ...CnYJSTATLI2:IP_ 4 - <br /> iL UcENSe C-42 L1 C-36 OTnfR <br /> NUitHF,A E7:➢!RATION I)ATE <br /> WA7 TABLEDEP7H: ft GEOGRAPHICALINFORMATION: Coordtn2fe3 X <br /> S TTtST * Y <br /> — BUILDING PERMIT# LAND USE APPLICATION# fI- -Lf <br /> 'TYPE O i K: U NEW INSTALLATioN GI REPAtR/AtH)fTION <br /> L3 REPLACEMENT O ENOtNEER DESIGNEDIALTERNATIV£ <br /> O DESTRUCTION <br /> INSTALLATI()N WILL SERVE: Q RESIDENCE Q COPIMERc1AL <br /> J O7NER <br /> NUMBEfOP LIVING UNITS: NUMBER OF BEDROOMS: <br /> y NUMBER OF EMPI OYEES: <br /> Q SEPTIC YANK TYPE/N1FG <br /> CAPACITYi <br /> 887 a OP COMPARTMENTS 3 <br /> 0 GREASEh"RAP 7YPEIN;FG <br /> f CAPACITY <br /> $al aOFCOMP'ARTMEN75 <br /> I Q PKG TX PLANT DtSTANCETO NEAREST: WELL ft FOUNDATION i <br /> 3 ft PROPERTY LLNE •- ,: R <br /> 0 LIFT STk`r10N SIZE TYPE OF PUMP <br /> I D SAND OIL SEPARATOR(ENCt.OSED SYSTE.Nt) <br /> 13 LEACH BINES 0 LEACHING CHAMBERS a OF LINES LE.NG7H OF LINES <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE '. <br /> a FILTER BD WIDTH _ ft <br /> 111111 ft LENGTH h DEPTH R �� . <br /> DISTANCE TO NEAREST WELL R FOUNDATION }t PROPERTY LINE <br /> (3 MOUNDS WIDTHfl <br /> R LENGTH fl DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE I{ <br /> © SUMPS `. WIDTH i <br /> ft LENGTH ft DEPTH g <br /> DISTANCE TO NEAREST WELL fi FOUNDATION ft PROPERTY LLNE ft <br /> O DISPOSAL;PONDS WIDTH— R LENGTH 8 p ` <br /> it <br /> DISTANCE TO NEAREST WELL R FOUNDATION_ R PROPERTY UNE fl <br /> L1 SEEPAGE!'ITS NLTvIBER WtbTN R DEPTH <br /> It <br /> DISTANCE To NEAREST WELL_ ft FOUNDATION ft PROPERTY UNE It <br /> t HEREBY 6RTIM THAT 1 HAVE.PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> i ORDINANCES,STATE LAWS AND RULES AND REGULATIONSOF SAN JOAQUIN COUNTY. <br /> 1' <br /> 4 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CAI.!.(209)953.7597 <br /> SIGNED TITLE eJ(, AIAJ Q DATE /-.' 0•/3� 1 �: <br /> k i <br /> L g Ri <br /> ' j <br /> i <br /> f <br /> i <br /> T -TT <br /> �t <br /> T FT 0 <br /> { <br /> i <br /> I i V <br /> 1 A <br /> DEPARTVIEN7 SE O'Ly I <br /> .....r._.,,._.._.:�.s_ <br /> Appltcat}an Accepted ByFmp7byWIDr <br /> Final Ins ton i <br /> C>� �' rYAt¢_ I3 SPECIAL PERMIT-Approved by <br /> Chan¢trr of Solt!A th of 3 • � Pi urtTp S Character: <br /> COMMENT'S �j ✓ �� <br /> PESC Rece{ved Cheak#1 AmoUn! Per- <br /> Cade INFp BY as Rem{tt¢d Dau Service R gcli p Invoice# Permit IDa <br /> t2-D:-007 ONSITE WASTEWATER PERMIT <br /> i:1221ZW3 , <br />