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-4 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT � <br /> SAN JOAQUIN COUNTY ENVIROHMBNTAL HEALTH DEPARWENT 800 E MANS 971I187-STOCKTON CA 9=2-(2091488.3420 <br /> NON-REFUNDABLE PERmirr CALL 209 953-7697 FOR 1MVECriolis EXPIRES'I YEAR FROM DATE IsSuED <br /> Joe ADDRESS <br /> CROSS srReeT L��L t7f3/1•�t� APN �✓ " PAOM <br /> OWNER NAME Z •err I r--.. I'If4 t ,y Z&9' 3-3 3lS%,d' �. <br /> OWNER ADDRESS G+1� CYTYIHTAT Jz. J7.•te'o CO. <br /> CONTRACTOR yj f�Y� �er /i—,/ . PiKN� /7i.PS— z �f <br /> CONTRACTDRADORESS A40 iaid >4 7 r�p CttYI(iT'ATBIZIP P I .i�JI✓, /�.i2- ,�, <br /> LtCEN&E IjC 38 OTHM Z-4.I Nuvwx Xf AEXPWAT=40ATWt X7, <br /> WATER TAsLe DEPTH: ft GEOGRAPHICAL INFOtMATIOW. C»oninatft K Y <br /> 0 FERC TEST # 1 SUnAMO PERNT ik — -- LAND USE APPLICATION� <br /> TYPE Of WORK. 0 NEW WSTALLATM3N iJ REPAWAD noisiu_,�+L�N�O`NdELIt DEsiGNeo/ALTEgNATWE <br /> D REPLACEMENT 0 OUT•OFSERVICE SEPTIC SYsTCM .+�..PE&TRuC1r L <br /> INSTALLATION WILL SERVE: 11 REsaOCNCE 0 COMMERCIAL 0 OTHOR <br /> Numm OF LIVING LkTS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYE88: j <br /> +.Z:'—"SE TIOTANK TYP.JMIG CAPACr1-Y Oat #OFCOMPARTMENTS <br /> Q OR£A8E TRAP TY?EIW,3 CAPACITY 921 0 OF COMPARTMENTS <br /> DISTANCETO NEAREST: WELL, ft FOUNDATION ft PROPERTY LINE ft <br /> Li LIFT STATION Si2E TYPE OF PUMP O PKG TX PLANT a SAND OIL SEPARATOR jF NCLOSED SYSTEM) <br /> O LEACH ONES C LEACHING CHAMBERS *of LNA19 LENGTH OF LINE:; R <br /> DISTANCE TO NEAREST WT9.L ft FOLNNDATICN•'�'""= A FROPERTYLWE h'4. <br /> Q MLT@/+CSED WmT}I _ _ ,__ft LENGTH ft DV_TH <br /> �DISTANCETONEAREST WtLl• ft rOUNDATKXd':.`. ? ft''"F`t' ERi'Y Ut =" -•� 7I R <br /> i C3 i440UNDED W OTH ft LENGTH _ ft .. "DEPTH <br /> DISTANCE TO NEAREST WELL R FOUNDATION _ ft PROPERTY LMF, A <br /> 13 SUMPs VADTN ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE_ ti <br /> 3 DISPOSAL PONDS WTOTH ft LENGTH it DFrTw ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> D SEEPAGEPITS NUNIGER ___.. WDTH_. R DEPTH ft <br /> DLSumcrTONEARtST WELL ft FOUNDATION ft PROPERTY UNE <br /> ' 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, I <br /> STATE LAWS AND RULES ANO REGULATIONS OF SAN.iOACJ,N COUN^?. <br /> 1 1Mum HO Q VAUV C 1CE REQUIRED FOR 1N P 1 S ALL 12179 BSX769 <br /> SIGNE0 TITLE DATE .--1`L L/ <br /> IL <br /> l <br /> ! I f <br /> I i <br /> 1 <br /> - - T <br /> i t - <br /> � y <br /> I <br /> DEPARTMENT tl P_O W <br /> Application AtceptaaT ...... �.. "``�''...{� '�/- - "• --wrti+- <br /> I - <br /> Final!inspection 8 c' �r Data /1� t" SPWAL PERWT-Appwad by <br /> Character of Soil t of 3 F p� SO oit <br /> CGA--IMIENTSM. <br /> I{I PE 5 . . I WICOived __. _Amaunt Date POMW lnvotea R Parrit(L IDtY I <br /> I Code INFO 8 s _ Serv7ea uastf <br /> S, r mmsd I>'I 1,n <br /> ' i f <br /> 62-01 ONSITE WAMWAT'ER TRTMWT SYSTEM PERMIT <br /> oratno <br />