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SAN JOAQUIN COUNTY EmaNONMENTAL HEALTH DEPARTMENT 1868 E. HA2B_TON AVENUE -SToCIOON CA 95205- (209) 468-3420 <br />NM -REFUNDABLE PERMIT CAL 209 953-7697 FON INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />.106 ADDRESS I. CRY/ZIP LC) ID i <br />CROSS STREET S APN 4:16L-0 q0is .8? PARCEL SIZE i s; 6 <br />OWNER NAME Ca OYY1PS p. Loci • 1-1-7 I • I 01(0 <br />BUILDING PERMIT # <br />REPAmIADDinoN ENGINEER DESIGNED /ALTERNATIVE <br />OUT.OE-SERWCE SEPTIC SYSTEM DESTRUCTION <br /> <br />INSTALLATION WILL SERVE 7 REsmoice COILLAERCIAI OTHER <br /> <br />NUMBER OF LAING UNRS: NUMBER OF BEDROOMS; NUNDER or EMPLOYEES: <br />as Wow . Cm/STATE/2m <br />CoNmAcion CCeCtd &0410e tv1.(Nom CC1• 334 • 73/ q' <br />CONTRACTOR ADORESS 33 Roo/46k &I-. Cur/STATE/Zip LCIPICt ot52-4,0 <br />LICENSE C-42 flC46 OTHER NUMBER S51 157 EXPIRATION DATE 2023 <br />WATER TABLE DEPTH: iao C) ft GeoGRArmou.INForsteaton: Coordinates X <br />TYPE OF WORK; NEW INSTALLATION <br />REPLACESIEt‘yT <br />PERC TEST # LAND USE APPLICATION # <br />CI SEPTIC TANK TYPE/MFG CAPAOTY gal # OF COLVARTMENTS <br />U GREASE TRAP TYPE/MFG CAPACITY gal ROE COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft U UFT STATION SIZE TYPE OF PUMP 0 PRO TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />ii./ LEACH U NES LEACHING CHAMBERS 1111g kiYC44-DY 5 # OF LINES 1 LENGTH OF LINES 103 ft <br />DISTANCE TO NEAREST WELL irk ft ,.. FOUNCAT1ON tcp ft PROPER IT UNE 6 ft <br />CI FILTER BED WIDTH II LENGTH ft LEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNCATION ft PROPERTY UNE ft <br />CI MOUNDED WIDTH ft LENGTH ft DEF7H ft <br />DISTANCE TO NEAREST WEU. ft FOUNDATION ft PROPERTY LINE _ ft <br />CI SUMPS Warm fl LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY I NE ft <br />CI DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAR -7 WELL ft FOUNDATION ft PROPUITY LINE ft <br />la/SEEPAGE PITS NUMBER 2 WIDTH ..g IP " ft DEPTH ZS 6 rt <br />DISTANCE TO NEAREST WELL \ 50 ft FOUNDATION 1 0 ft PROPERTY LINE C) It <br />I itREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />/811W 4 OU ADVANC NO77CE REQUIRED FOR INS n piECT 0 S - PLEA CALL 0091953-7'97 <br />SIGNED <br /> <br /> TITLE Al ft) DATE k) 2-1 <br />.------ .,\)________T <br />ukt) PL Atti, <br />acip <br />\t/41,V• <br />, <br />I <br />Application Accepted By 4 ."'" Li-- <br />DEPARTMENT USE ONLY <br />Area 41/9 cif Employee 106 Date /Vs I.1 I <br />FInal Inspection By Date n SPECIAL PERMIT . Approved by <br />Character of Soli to Depth of Ft Sump Soli Character: <br />COMMENTS F,11 11, ns5 SYS trYll • EA /11-10,5 /41 rs <br />PE <br />Code <br />SC <br />INFO <br />Received <br />Itly <br />Chscldir <br />Cull , <br />Amount <br />Remitted <br />e Permit/ <br />e R 9 Invoice 9 ..ap Permit UV I <br />qaio - i/ de9- ed ((it #3.3-b 1 1 5 <br />(r <br />5 3ve <br />I <br />42-01 <br />4/14/111 evitc 133 /7 73`,1 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT