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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT LEf-Uq0Z <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 500 E MAIN STREET-STOCKTON CA 95202-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 289 953.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> II `` l� i <br /> JOB ADDRESS 1.r1�7 F�7-n.k-Cr lzc nGT CITYlzIP '(0 -4 :r) <br /> CROSS STREET �-x- -�-- E '.\ci Gj APN G�Ci ri - I CF rI PARCE S E _. t•�G c <br /> OWNER NAME E stl,. ?.I/t! ` r'II� t(..L-€', `jar f( � �;nl"€ill.t:.iil(�1 'PH1ON lclrl� t <br /> OWNER ADDRESS _! H.__(�,ISI�)... �}�-. � � CITYl$TA7E21P I)1�L I'� 8 <br /> l <br /> CONTRACTOR `s, a�,�'f PHONE .G•t^''-I I '��(7" <br /> CONTRACTORADDREa3 ,G 4 1 I lAu�,I^r ii( I �'11�/ CITYISTATE21P �-( Ai 6A r0,2 t-( <br /> LICENSE 4C.42 QC-36 OTHER �+S T NUMBER 1�✓ L'6 ExPIRAnoN DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: COOrdinateS X yam_ <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# I U <br /> TYPE OF WORK: ❑ NEW INSTALLATION IJ REPAUIIADDITKIN Q ENGINEER DESIGNED JALTEANA";. <br /> D REPLACEMENT ❑ DESTRUCTION <br /> �Y INSTALLATION WILL SERVE: ❑ RESIDENCE 0 COMMERCIAL ❑ OTHER - - <br /> NUMBER OF LIVING UNITS: NUMBER OF BEOROOMS: NUMBER OF EMPLOYEES; <br /> LI SEPTICTANK TYPE/MFG - .: . <br /> CAPACITY gal #OF COMPARTMENTS <br /> I] GREASETRAP TYPEIMFG CAPACrTYgal #OFCOMPARTMENTS_. <br /> DISTANCE TO NEAREST: WELL ' ft FOUNDATION ft PROPERTY LINE. r.-e:.I, f?ft <br /> O LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT Q SAND OIL SEPARATOR(ENCLO$E�SYSTEM► '? <br /> r, <br /> O LEACH LINES n LEACHING CHAMBERS #OF LINES a rxx A <br /> J _ LENGTH OF LINES - _ ft` <br /> 1 DISTANCE TO NEAREST WELL - RFOUNDATION ft.: "PROPERTY LINE'Iw*rhw ^w - <br /> fte <br /> ` 0. FILTER BED WIDTH ft LENGTH ft. OEpTHrr > " �ft,k V <br /> !- DISTANCE TQ NEAREST WELL R FOUNDATION ftPROPERTY LINE <br /> 13 MOUNDED WIDTH ft, LENGTH it. DEPTH w Yft <br /> -� - DISTANCE TO NEAREST WELL ft.FOUNDATION ft PROPERTYLIKE - ft <br /> 0 SUM P$ �a WIOTiI ft';F LENGT H. "'--. lx DEPTH d 3 ti 4 <br /> wft <br /> DISTANCE FO NEAREST W0.L $ ft FOUNDATION „JftipROPERTY LINE = ft <br /> O DISPOSAL PONDS WIDTH;9 ft ALENGTH .tom' ^' ft' V DEPTH <br /> DISTANCE TO NEAREST 5 WELL / 'ti ft EDUNOATVON- '��. ft ;F- PROPERTY LINE t -M <br /> Q SEEPAGE PITS'. Nu eR L L �t� �n WmrK r .`Y ' -x ", <br /> ft DEPTH <br /> x. .r - ft <br /> G x E y �,DISTANCE TO NEAREST }vWELL" `Lv1p ft FOUNDATION C ft,: PROPERIY.LINE _ fl <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL bU <br /> BE PONE IN ACCORDANCE WITH SAN JOAOUIN CQUNTY ORDINANCES , <br /> STATE LAWS AND RUL FS ANLC <br /> JiEGULATIOIVS O�SAN JO <br /> _ y I IMUM 24-tIOUR ADVANCE N_p710E REQ UD FOR 1NSPEC'1' S PLEASE CALL{209)953 7697. F /„ '*. a ,� �, <br /> 4'4 K <br /> TENTATIVE PARCEL MAP y$ tx I > <br /> 1 <br /> k. <br /> ME <br /> r N E n, <br /> 3 <br /> ir <br /> .r <br /> l DEPARTMENT USE ONLY 4:/ <br /> Application Accepted BY -__7'i4.�.L..� Data v�%-'/L Area EmployeelD# s"c <br /> ' Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character Of Sall to Depth of 3 Ft: PIVSpmp Soil Character: <br /> a COMMENTS <br /> PE Sc ReceivedC_hecic#! Amount Date Permit! Invoice# Permit ID# <br /> Code INFO B Cash ,Remitted Service Request# <br /> 4_ <br /> 42-01 r)NSITF waerclueTr`o Terl,ar.lr everc..oen..i. <br />