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T ONSITE WAS `, ATER TREATMENT SYST I` PERMIT /� <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH n1ri wrMENT 304 E WEBER Av' .-A""FL-STOCKTON CA_95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> 2.1L ,rd <br /> DC16_P gsz3� <br /> JOB ADDRESS '�f v ��0�/✓�Ol CITYIZIP <br /> to <br /> CROSS S'I'R}:}:'1' ✓t{kf2A , APN V' ` 3-)-o - ob PARCEL SIZE 19 ] rt3] C <br /> v <br /> Owmm NAME <br /> ONVNt:RADIIRI.SS 12 o • ��_ �r �(t�lJ`` CITYISfA't'FM11' �t7lllt�, T/��7 __�535te -- <br /> CON'I'RACrOR S1�1 r �,UL y PHONE �� T �Q3�.d,L� <br /> CONTRACTOR ADDRESS (�(r L VL(M/S DVC V�GyI�V CiTYISTATE/ZIP L'194 CA <br /> - <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TA BLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> n <br /> PERC TEST(S) ' NUMBER 1 LAND USE APPLICATION# T1 '-D3 `S-O'+ <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> i <br /> 1 INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: Numm,.R OI;13F.DROOMS: NUMBER OF EMPLOYEES: SL <br /> ❑ SEPTICTANK 'I'vPIJMFC — CA PAC I'I'Y_ gal dOFCOMPARTME-NTS <br /> ❑ GREASE TRAP TYPEaMFG CAPACHY gal #OFCOMPARTMENTS <br /> { ❑ PKG.TX PLANT DItirANCE'1'O NEAREST: WI:I.I, _ II I"OUNDATION 11 PROPERTY LINE It <br /> ❑ LIFTSTA'tION SIZV, I'V'Pr:OFPUMP ❑ SAND OIL SEPARATOR(ENCLOSEDSYSTEM) <br /> ❑ LEACII LINE'S LI L,EACIIINC:CIIAMBERS 8 OF LINES LENt:TH OF LINES II <br /> DIS"I'ANCE'.'rtl NEAREST Wl;ILl. Il FOUNIIA'I'ION Il PROPERTY LINE: It <br /> II ❑ FILTER RED Wm-rH tt LENG-I'll ft DEPTH tt <br /> € DISTANCE TO NEAREST WELL 11 FOUNDATION ft PROPERTY LINE ft <br /> f ❑ MOUNDED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL 11 FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WID-I-II ti LENGIIi 11 DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WmTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ SEEPAGE PITS WIDTH It LENGTH - ft DEPTH ft <br /> DISTANCE TO NEAREST WELL fi 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 ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM fh24I HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 �( <br /> SIGNED 'vZA' v' k1" 1 f" -MC•TITLE &1Li01'p-y1yk���al,¢ �IPCf�I& DATE <br /> 'I <br /> ^ `3y ckhm S A 1 C <br /> N IFI <br /> o <br /> U S <br /> my <br /> FPO, MOAD <br /> i <br /> DEPARTMENT SE ON Y <br /> Application A=5.i3 <br /> ' —"L Date ` 4L Arca Employee ID# <br /> Ir <br /> Final Inspecti Date ? (S ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil tothofofFt: yrt 't/Sump Soil Character: <br /> } COMMENTS <br /> r , <br /> PE SC Received hec Amount Permit/ <br /> Code INFO R Cash Remitted Date Service Request# Invoice# Permit 1D# <br /> �y I`7 <br /> 42-01-00f <br /> I <br /> 1212101 ONSITE WASTEWATER PERMIT <br />