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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> -` SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3Re FL-STOCKTON CA 95202 -(209)468-3420 t <br /> NON-REFUNDARLE PERMIT "-z "'�CALL 209)`953.7697 TOR INSPECTIONS EXPIRES 1 YEAR FROMDATEISSUED <br /> C[TYIZ1P 'f r LL 1 `fix' <br /> JOe ARORESB <br /> L J V" J -PARCELS= <br /> OWNER NAMEµ .- n +( F' " ✓r�• �Np:I t - PHONE l`.i} i�� <br /> OWNER�ADORE55 - C]TYISI'ATEIZIP <br /> CONTRACTOR-= PHON•e <br /> I .�• S <br /> CONTRACTOR ADDRESS C[TYISTATE/Z1P <br /> IpE[ LICENSE'' ❑C42'` MC-36 OTHuR --- - NUMBER EXPIRATION DATE <br /> F ,- WATERTABLEDEPTH ft GEOGRAPHICAL INFORMATION: Coordinates X Y N <br /> ffllflfk �1l_m PERC.TEST.-.;tl � .t BUILDING PERMIT#' LAND USE APPLICATION# <br /> ';TYPE OF WORK ':- -❑ -.NEW INSTALLATION ,, -L'.❑'.'r REPAIAIADO[T[ON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> k P .'Y':' k i+.: ❑ �:F;.REPGACEMENT x .'❑^DESTRUCTION <br /> r INSTALLATION WILL SERVE. ❑ RESIDENCe = "O'COMMERCIAL, ❑ O'T'HER v} <br /> f <br /> .'NllMTIEROFLIVING U N17s.� 'k " NUMBEROFBEDROOMS NUMBER OF EMPLOYEES: <br /> ` ❑ $EPTIFC tTANK TYPelMFO 'CAPACITY gal #OF COMPARTMENTS <br /> 1 ❑ GREASE TRAP 7YPEIMFG - r CAPACITY - 'gal #OF COMPARTMENTS <br /> r - ❑n P11((G TX PLANT DISTANCE TO NEAREST WELL- r fl'-"FOUNDATION ft- PROPERTY LME <br /> I ❑V- <br /> LIFT STATION" �_;SIZE . r � TYPE OP PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> '❑ -,LEACH LANES-`� CltLEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> DISTANCE 70 NEAREST WELL, x" RFOUNDATION ft PROPERTY LINE ft <br /> F4 F - - <br /> .(❑ rPiLTER 8ED j. - WIDTH -Sf- R LENGTH ft DEPTH ft <br /> -y `DISTANCE TO NEAREST 'wELL <br /> X."_F_OUNDATION ft PROPERTY LME ft V <br /> `.-❑__MOUNDED ..WIorR 'ft LExGrH. - - A DEPTH <br /> _ <br /> ftr <br /> DISTANCE 70 NEAREST WELL '�FOUNDATIDN, - ft PROPERTY LME A <br /> j ❑ �SUMPSt -WmTH t ft,i LENGTH .... ft DEPTH ft <br /> ,3S <br /> DISTANCE 70 NEAAESi WELL R FOUNDATION ft PROPERTY LME fl <br /> _ ❑ r DISPOSAL PONDS',Wurrx -4 LExcrR-' •"=t3.�": DEPTH t3 <br />[ DISTANCE 7D NEAREST WELL s ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER '"0• 5 WmTH�7 ,7, <br /> ft' DEPTH ft <br /> ° I DISrANCETONEAREST .WELL ft FOUNDATION ft PROPERTY LINE ft <br /> y6 f HEREBY_CERTIPY THAT I HAVE PREPARED TH15 APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY _ <br /> ORDINANCE$STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY:. <br /> P MIi1iM UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697, .._-MTLE r-- -- 5 ��,,._. DATE <br />, F i <br /> 4 <br /> ku'ieaVc_ leer <br /> K <br /> 4-i <br /> P.1 <br /> `� <br /> T <br /> I Pivea.a CJA i <br /> L <br /> U <br /> _ r-~-soln+l raRPot§T RAY 5FN Sapi <br /> TitI <br /> N <br /> I NLS <br /> - - - ''DEPARTMENTUSE ONLY <br /> - Apphcatl6nAeceptedBy -- §-DelolLl�d 1L3'S' A[ea'- 'ZI I,B Employee ID# <br /> Flnal Inspection Ry Bete T ,Q SPECIAL PERMIT-Approved by <br /> .I <br /> ,- Character of Soil to Depth of 3 Ft ` PIt(Sump Soil Chametert <br /> COtvIMENTS <br /> PE SC Received (Chksky .Amount Permit! <br /> $ Code INro 8 Cash- Aemitted Date-.'. Service Re uest#Rl ]nvolce# Permit[D# <br /> �2Z`2 SSI N' cj'z, t71y 5rzo, S14y <br /> .. _ <br /> I <br /> 42-62-061:„ Y i I ONSITE WASTEWATER PERMIT <br /> 12l22l2661 s <br /> a< <br />