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i ONSITr!iWASTr' -LATER TRTATMENT SYSTE�'ERMIT SSAN JOAQUIN COUNTY ENVIRONSWNTAll IIEAIXII DPA ,ISN'T' ..1404 E WEBER AVi FL-STOCKTON CA 95202 - (209)46K-34211 NC N-R1:FUNDABLE PERMIT '! CALL(209)953-7697 FOR INSPF:C IONS CKPIRES I YEAR PROM DATE ISSUED L, LA JOB ADDRESS �^ QCITYIZ1719— IIP /1 I L CROSS STREET J 1L !'� APN / /D! PARCEL S[ZE fC✓ � OWNER NAME G Fb L ZJ! PHONEWA �i OWNER ADDRESS � � � )IV CITVISTATEIZIP 9�a, I CONTRACTOR ��'� 'E PHONE CONTRACTOR ADDRESS . CITYISTATEIZIP LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST(S) NUMBER II LAND USE APPLICATION# TYPE OF WORK: Cl NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT bESTRI CTION INSTALLATION WILL SERVE: RESIDENCE © COMMERCIAL L3OTHER ( /� NUMBER OF LIVING UNITS: ! NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 1 f � ❑ SI:PTICTANK TVITIMFOCAPACHYgal 0 OF COMPARi'm rwrs ❑ GIMASE TRAP TY11FIMI'Ci-------_ CAPACI"I'Y gal N OFCOMPAR'I'MENTS n ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL 11 FOUNDATION ft PROPERTY LINE ft it ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) C7 ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft Ij DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it ❑ FILTER BED WIDTH ft LENGTH ft DEPTH fl p i DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ti E ❑ MOUNDED WIDTH Ij it LENGTH fl DEPTH ft DISTANCE To NEAREST WELL tt FOUNDATION ft PROPERTY LINE ft D SUMPS WIDTH IM It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft C7 DISPOSAL PONDS WIDTH tt LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS WIDTH I It LENGTH li DEPTH ft DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, ATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. W�4113"RADVANCF NOTICE REQUIRED FOR.INFICTIONS-PLEASE CALL(209)9 -76 SIGNE 1'17'LE E �i s - ii i I� �I.INnel vl frr.rnr ar rr..l•n..ev�irr rx ndrrxlm6 ny Ixrywrry . IJ r.Mrnx..rl rlr.rn,fy,r,VFn.'Jwrensrxn wu NurIM1 4r K,in. I� •�W wnu.you H.ca..amNruwryanunrrm�etlnx.crure..Lrc4arrnVcoKr.Jwe.flun.f Wird, y f.Ie[.vnr el lorry rrnar mnlri,�rw.Fn fwrw,mwnVe tlnWaal avfMm a M•owfJ arvyn eaperq uraf�r, IIS.L.4en al ollgr'x+ri0 TNN rxV�SOI IIS Malydrtlq alVn MyiellnwWWfwllnrNlrun �f a w.rry r..0..r,r.,,.I rr•ee wr wryaew prcpl.ry rx.tlpNarq FnArry. _ ]W dnwOr a I.,rM1N.rwJleaU ISO 4n,} Ro k �-I•-;- i I j � I i t II +I I_� I I wrcnrri II ! i j i t I � o o harwl I II I! A N C 30. II Q ,r r { - I_ = , I DEPARTMENT USE ONLY �7 ! ccs Application Accepted B Date / F Area �`��I Employee 109 G / Final Inspection By Date e /—C3 ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Q PitlSump Soil Character: i � q COMMENTS r. z,.�s S Ii d r.Ca.L([n( "a. � ''•� '5; ' II PE SC Received Chcc Amount Date Permit/ Invoice# PermitID# Code' INFO By 1p Cash Remitted Service Request# 42-01-00] 12/2102ONSITE WASTEWATER PERMIT