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ONSITE WASE VATER TREATMENT SYSTE,1 PERMIT <br /> SAN JOAQUIN COUNTY h;NVIRONMENTAL IIEAI,'[H DEPARTMENT 304 E WEBER AVE -3""FL-STOCKTON CA 95202 - (209)469-3420 <br /> NON-REFUNDABL'' PERM]'[' CAL 209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOR An1EH l{.tiff y CITY/ZFP <br /> Lrrjzr <br /> , 05t- 320-c6 3 <br /> M <br /> CRESS ti'rRF:E:'I' APN PARCEL SIZE19 ,93 <br /> ,� /� I•NV/� 0 <br /> OWNER NAME. t E7 C U� T_�r.,5 c PIHONNE`y - - ^ <br /> `x r � ilk.{!) � 7535`) y <br /> OWNER ADFERF;55 .`/\ �/� (�(� 1 r/�+ K � tp C1TY1$TATElLIP ` ,- <br /> CONTRACT'ON �'i�1 G i4r{c� ` 5'I,J�J 1 C PHONE <br /> CONTRACTOR AD up,,s y CITYlSTATFIZI <br /> LICENSE: C-42 LlC-1601'1WR ;rQ 'S NUMBER im EXPIRATION DATE <br /> WATER TABLE;DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NFWINSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ RF,PI,ACEI1tENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE 112rCOMMERCIAL ❑ OTHER --y <br /> NtIMBF,R OF LIVING UNITS: NUMBF,R OF BEDROOMS: NUMBER OF EMPLOYEES: r <br /> 1w SEPTIC TANK TYPE/MFG ;til —f <br /> CAPACITY � a #OF COMPARTMENTS <br /> C3 GREASE TRAP TYPE/MIG CAPACIT gal OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE'r0 NEAREST: WELL_ ft FO_UNDAT R PROPERTY LINE ft <br /> tl <br /> LIFT STATION SIzE; TvPE OF PUMP <PAI I ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> i� <br /> LEACH LINES LEACHING CHAMBE �Cl— <br /> #OF LINESLENGTH OF LINES 150ftIv <br /> DISTANCE;TONEAREST WELLNDATION V ft PROPERTY LINE �1 d�J _ft c- <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL. ft FOUNDATION ft PROPERTY LINE ft ` <br /> ❑ MOUNDED WIDTH fl LENGTH ft DEPTH ft 17.1 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R � <br /> ❑ SUMPS WIDTH Il LENGTH ft DEPTH ft <br /> DISTANCE.T(1 NE:ARE.S1- W1,1.1 _ Il FOUNDATION a PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WID'ru 11 LLNGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUn ATION ft PROPERTY LINE R. <br /> SEEPAGE PITS NUMBER WIDTH y� It + ft DEPTH ft �f <br /> DISTANCE TO NEAREST WELL E ft FOUNDATION R PROPERTY LINE R <br /> ]HEREBY CERTIFY"i'HA'i•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 /> NE IM v 4 HOU AI V N F NOTICE REQUIRED FOR INS IONS-PLE E CALL(209)953-7697 <br /> 1, SIGNE �4� � - <br /> TI TL DATE <br /> ( <br /> 1 43 v <br /> U J4 <br /> 1 <br /> X � <br /> { <br /> r � <br /> 1J � - <br /> � 1G <br /> I <br /> y1 4 L <br /> 1 <br /> 1 <br /> JA IM <br /> iz�rl <br /> TA <br /> 1 �� DEPARTMENT USE NLY ENT r <br /> Application Accepted B'f �� to / t'1 .� Area 21 2_ Employee ID# gl <br /> Final inspection By Lam: Date 5 ❑ SPECIAL PERMIT-Approved b <br /> Character of Soil to Depth of 3 Ft: ( f•✓..r Pit/Sump Soil Character: L. 11-01002�1 4 <br /> COMMENTS 6A& 0 4 Fr,err M�D r[4yE <br /> � /l.i 1.��'"��:.;f r] �• C'.�c•�<-r�'F.� 1 E��� "���Jy'_.5 tc,K nJ e �F ?�~? 7'7��+v� . <br /> PE SC Received h Amount Permit/ �6r6 <br /> Code INFO B Cash Remitted �7Date Service Request# cc r it <br /> ' i.4 <br /> Jy�d -ALVA IcPEI?!42-12-001 ( <br />