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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAM JOAOUN COUNTY EMW ROMWWTAL HEALTH DEPAxrkm T Tttd E HAzFLTON AvEMUE - S TOC RTOM C• BSNIS . fJOA l ILB_L]e <br />Mumf(EFUNDABLE P <br />RETLACHIENT <br />LL <br />953-7997 FOR INSPECTIONS EXRR 1 FR DATE ISSUER <br />Joe ADDRESB <br />COMMERCIAL OTHER <br />I iC Lf <br />/YEAR <br />Cirirr 11 1-0 % / <br />om <br />CRSTIIETn <br />"1 V^ V <br />;% <br />CAPACITY gal BOG COMPARTYEIRS T <br />APN l ICY %a PANC4 SUS I , ;.• <br />OWNER N-9--i4z <br />y2 Cil' / GiV <br />Ir <br />Zi'7 yc' ! F <br />pmms <br />OWNER ANNHRass �n ('� <br />❑ LIFT STATION <br />.L <br />CITYISTATEMP <br />CONTRACTOR �C D�N <br />I <br />I <br />-q eA' <br />PHONE,_[]so <br />CONTRACTOR ADDRESS _ <br />%ll/ <br />3 7 -/ l( <br />j'''' <br />f(j Zr <br />,-'CSN �'� C.STATERIP -5kc0,,, ( <br />LICENSE —2 <br />caa OTHER <br />4111, <br />NUMBER ys� ExPH1AT10N DATE <br />WATER TABLE DERV: R GEOGRAPNCAL IMFoRMAnom: GNHd41atn X Y <br />!ERC TAT B BUd.DING PERMR # LAND USE APPLICATION # <br />,DEPARTMEN I's <br />APPIX-Oon ACcapted By I 'r- Darts � -- "a LI L� EmpOYeo IDR f r'' I^ I� <br />Flml InspNNNbn By !1/ii.56IJ fQ-' 4jLj D.e. LtA/Z •L -L SPECIAL PERwT .Approved Dy <br />Charadar of Sad iaDepth OfIl R: RfSurnp Safi Character: <br />COMMENTS V '�F+�' J VT YIP ? I P r .11 . -n in k r> lq I I ill./ k,,I k <br />Invoke 0 1 ►BnRd of <br />3JZ) <br />42-01 CNWTE WASTEWATER TRTINT SYSTEM PEFLNT <br />VINE <br />RE Y�EN� <br />CEIVED <br />MAY 0 3 20,92 <br />S IV ENVIRONrN COUNTY <br />HEALTH OE ARTMENT <br />6 . <br />RETLACHIENT <br />OUT-OF-URWCE SEPTIC SYSTEM DEETNUCT7011 I L 1'I I'� <br />INSTALLATION WILL SERVE: RESIDENCE <br />COMMERCIAL OTHER <br />NUMBER OF LNmr UNITS: EA Of BEDROOMS: NUMBER OF EMPLOYEES: <br />),.! <br />SEPTIC TANK <br />/ <br />TYPEIMFa y <br />;% <br />CAPACITY gal BOG COMPARTYEIRS T <br />❑ GREASE TRAP <br />TYPEIMFG <br />CAPACITY gal B OF COWART Dns <br />DIaTMCE TO NEAREST; WElL 60/ <br />R FOLalwnpl 11 PROPFFfY LNE !E5(0 / R <br />❑ LIFT STATION <br />.L <br />SCM TYPE OF PUMP <br />❑ PKG TA PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />'X LEACH <br />SS <br />LINES <br />LEACHING CHAMBERS <br />a OF LNEs LENGTH OF LNEs ft <br />4111, <br />DISTANCE TO NEAREST WELL <br />ft FOLNOATIO R PROPERTY LINE <br />1 O mm. <br />W. R LENGTH <br />R DEPTH R <br />DISTANCE TO NEMEST WELL <br />ft FOUNDATION R PROPERTY UNE R <br />D MOUNDED <br />WDTN ft LENGTH <br />ft DEPTH R <br />DSTMCE TO NEAREST WELL <br />R FOUNOAnO R PROPERTYLINE R <br />❑ sumps <br />WoYm ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />R FOUNDATION R PROPERTYLNE R <br />❑ DISPOSAL PONDS Wcnl ft LENGTH <br />ft DEPTH R <br />DISTANCE Nem <br />C <br />Y SEEPAGE PITS <br />TO UT WEI.I <br />NUMBIR I WRD„I <br />ft FO OATIGN ft PROPERTY LINE!; <br />Imo_ <br />3 R DEPTH <br />SP1 11, <br />DSTMCE TO NEMEST WELL <br />R FOUNDATION ft PROPERTY LINE LI J ft <br />1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IM ACCORDANCE WITH SRN JOAOUIM COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUN COUNTY. <br />,DEPARTMEN I's <br />APPIX-Oon ACcapted By I 'r- Darts � -- "a LI L� EmpOYeo IDR f r'' I^ I� <br />Flml InspNNNbn By !1/ii.56IJ fQ-' 4jLj D.e. LtA/Z •L -L SPECIAL PERwT .Approved Dy <br />Charadar of Sad iaDepth OfIl R: RfSurnp Safi Character: <br />COMMENTS V '�F+�' J VT YIP ? I P r .11 . -n in k r> lq I I ill./ k,,I k <br />Invoke 0 1 ►BnRd of <br />3JZ) <br />42-01 CNWTE WASTEWATER TRTINT SYSTEM PEFLNT <br />VINE <br />RE Y�EN� <br />CEIVED <br />MAY 0 3 20,92 <br />S IV ENVIRONrN COUNTY <br />HEALTH OE ARTMENT <br />6 . <br />