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4 <br /> WSITEaWASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 314E WEBER AVE-3`°FL-STOCKTON CA 95202-(209)468,3428 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> h !352-40 rn <br /> JOB ADDRESS t'+�I1f1'TLI 1'' AD CITY/Z1P1 pm _ =1 <br /> CROSS STREET ./[,IJIC/]�O�r-�'ry�`3wT'4!),1-f�_-(�V(T��yF�LJ/ AP'1�t1 a- 6 +�PPAA(R�jCEL�SSIIZZEEQ -4� <br /> OWNER NAME (Z(,JR(.�I/ S I V6/J� {Ly.�J�dt_(�V,D C�.() �[ &OL I �OV►y% P111ONF 1L--�i 7-1�63-(3�11113 � <br /> OWNER ADDRESS 5471[ -r+^r/S�,It� s_.G���I�Ly/r-�sc-4'+Ie�-•r4 L'-•- CFTY/STATE/EZIF' /// L�CJ1/J�(�C—A `y5_4 u <br /> CONTRACTOR D . QI 'W/IL�1L�7(�� �iyysJI�JIAP��S/ �/�IVC - PHONE 466 /� <br /> CONTRACTOR ADDRESS1LJl.(./ 1{/.W I4�,9%j •WA7 c TYISTATFJZI / ex <br /> " j LICENSEa XC-42 JC-36 OTHER NUMBER IC�F7.�� EXPIRATIONDATE�,��03 <br /> r\ <br /> WATER TABLE DEPfH:70'T1- D-I%W ft GEOGRAPHICAL INFORMATION: Coordinates X V_ ^' <br /> ❑ PERC TEST(S) NUMBER LANO USE APPL"TIoN A <br /> TYPEORWORK: ❑ NEWINSTALLATION ❑ REPAIR/ADDITION ❑ ENGINF,EROCSIGNEDIALI-ERNATIVE <br /> REPLACEMENT D( DESTRUCTION FJA-1N CLE7 J/�P•V� <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER__ <br /> NCMBER OF LIVING UNrrS: 'NUMBER OF BEDROOMS: NOMBER OFEMPLOYEES: ) <br /> XSEPTICTANK TYPE/MFGG-�v rFY�gal 0OFCOMPARTMENTS 333�rra N <br /> ❑ CREASE TRAP TYPFJMFG _-___ CAPACITY _ gat #OF COMPARTMENTS <br /> ❑ PKG TX PLAN DISTANCE TO NEAREST: WELL _ ft FOUNDATION - ft PROPERTY LINE _ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOsEDSvsfEM) <br /> TTCf1�- <br /> X LEACH LINES AC)iINGCHAMMBB��LtZG��L. 4OFLINES _ LENGTH OF LIN ES 75 ft <br /> DtwANCETONFAREST WELL t- ft FnIiNDATION 1, ft PROPERTY LINE 1 J' _ft <br /> ❑ FILTER BED WIDTH H LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL R FOUNDATION f) PROPERTY LINE <br /> ❑ MOUNDED WIDTH ft LENGTH Y IT DEPTH R <br /> DISTANCE TO NEAREST WELL__ft FOUNDATION!_ R PROPER TY LINE _ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL —ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WtDnl ft LENGTH_ ft DEPTH ft <br /> IIVTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> XSEEPAGE PITS WII_ ft LENGTH _ft DEPTH ft <br /> DISTANCETONEAREST WELL ft FOUNDATION t4- ft PROPERTY LINE �~ ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNT'ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 1 <br /> SIGNE��l3W`�"V MIUM7AHQ YANCENOTICEREQUIRED FORE TIONS-P EAST.CALL(209)"DA�EFii"�10:3 <br /> { <br /> r j -- <br /> ? a-tom V ►eSsi i-IatI'Tea <br /> C- <br /> �_.:.._ _,�.'73.�.�.._ ���•�)1 aid � _-- - J� -- _� <br /> AL <br /> - _--- 1 — - <br /> r <br /> t b- <br /> IF I <br /> Application Accepted By( I Dare yy Area plo ce IDX. '^_J✓��/' <br /> Final Inspection By Date ,3��/3 C1 SPECIAL PERMIT-Approved by <br /> Character OT 3RI!TO Depth of Ft: PiUSump 3011 Character: O <br /> COMMENTS <br /> PE SC Received -Chet Amount Date Perm t Invoice X Permlt IDX <br /> Code INFO B ash Remitted Scrvice Re uest X <br /> 4x..11 z4v Lp y <br /> 4I-0f-001 W wmplatw--s 1 SC0k w+12WS 2300 X,Z2-5--.--1,Y"T T(•b9T-vONSITC WASTEWATER PERMIT <br /> 12,'2/02 <br /> 3X4-+-42',c25% 320= 620tTowmietp) <br />