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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH EPARTM ENT 600E MAIN STREET-STOCKTON CA 95202-(209)468-3; <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRFS X YEAR FROM DATE ISSUE,- <br /> JOB ADDRESS o-KO �e • CITY/ZIPf <br /> Z 4W d PN 0�-I Z!�^ PARCEL SIZE H` <br /> I CROSS STREET � Z� L / <br /> OWNERNAME _ ��V— ZZ�o PHONE �ct — fez—/'`� — <br /> OWNER ADDRESS _ C;2 / '19A)1 �r CITY/STATE/ZIP <br /> CONTRACTOR PHONE on Inn. <br /> CONTRACTOR ADDRESS CITY/STATF/ZIP -C Na <br /> D <br /> r LICENSE ❑ C42 E3C-36OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: [7` f10 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # r BUILDING PERMIT# —a70.2�kI LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> Cl REPLACEMENT ❑ DESTRUCTION, <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ;i�-COMM-ERCIAI'Dr—r-C-4 ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: LLLL NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG CAPACITY Z�d gal #OF COMPARTMENTS L— <br /> ❑ GREASE TRAP TYPFIMFG CAPACITY gal. #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT C3 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES -7 ft f <br /> DISTANCE TO NEAREST WELL r �J `� ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH it LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft . PROPERTY LINE ft <br /> Jif SEEPAGE PITS NumsER WIDnI f3 DEPTH S ft <br /> // DISTANCE TO NEAREST WELL fU .+..G r-ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND'RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> / N931M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(2091953-7'697 <br /> SIGNED- Q /NA\,/ON = ROAD o o � <br /> 0 <br /> 50 <br /> -oil5TORM YATER ! _ <br /> RUN OFF!TO <br /> `O O 60 INTO.:(E) <br /> 13 <br /> �� 0 GHEI�RY°ORCHARD - , <br /> 14 <br /> RE�E1\/ED <br /> M,ACZ r��K_ v 1pRQvir�Ga�1"V <br /> L �, $A VIRp�-- MEQ <br /> w PAR <br /> IS <br /> f DEPARTMENT US ONLY <br /> y <br /> Application Accepted Date E? !S (3 Area Employee iD# 7 <br /> Final Inspection By - Date l [3 SPECIAL PERMIT-Approved by <br /> Character of Soil to Dep i of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> /.. �2��! ��-.Jc; •rS•�".+�C 3}r���1��� •� ;����Y+�-tom�>r2�,:r��1-�cae��G�.����'Y�-����.��,_ <br />�. PE SC Received Amount Permit/ <br /> Code INFO B Cash Remitted D to Service Request# Invoice# Permit ID# <br /> If 2-1 ko ��C <br /> IDL-3 roo.(7`) c1 400.<IVfi d' <br /> 2 �J.�SL�GL-Ur L1�1r ." ..� 7��/7lf.C.,��1��.'f�'CI�r'le�' ' ���}!�.�1�L/f'7�R•tIC•� <br /> 42.61 r / ONSITE WASTEWATER PERMIT <br /> ncnnr�nmSZr�IG�trillS�aY' t'oC'.• '7YF" /�-�fI2 .r�Ctf�2in Ari A. <br />