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` ONSITE! STEWATER TREATMENT SYSTEM l �r <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HFAL7N DEPARTMENT 309 E W'EBERAYE- <br /> 3"°FI.-STOcKTON CA 95,202 -(209)468.3420 <br /> NON-REFUNDABLE PERMIT C'AI.,I, 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JoaADDREss �4F - <br /> JF I,p;�� � 1 r•_e. .�°' �'+ CITY/ZIP <br /> 1 CROSSSTRLFT <br /> frE .ATN PARCELSIZE <br /> OWNER NAM1IE1 .•'k. 1,.� r,,C',4 ip <br /> PHONE'z,014 <br /> OWNER ADDRESS <br />+ CiTYISTATFJZIP'"'^.�. <br /> CovTRAcroR 4A a ; <br /> I <br /> ACIO SN _ZrPHONE <br /> LICONTRACTOR <br /> ENSE ZI C-42 CJ C-36 OTHER CTfSTATEfLIP °A„ <br /> URIRER <br /> Lt`.eO r I <br /> - E!(PIRATION DATE ° - :.) � <br /> WATER TAai.F.DEPTH: Il GEOGRAPHICALINFORMATION; Coordinates X <br /> Y _ <br /> $1 FERC PEST p ']!-�`: '�a;� BUILDING PERMIT# LAND USE APPLICATION# �i <br /> TYPE OI'WORK: S❑ -T4EW❑ INSTA LLaT]ON -� ❑ REPAIR/ADDITION <br /> ❑ EN'GINEERDESIGNEDIALTERNATIYE REPLACE:MENY LJ DESTRUCTION -- <br /> INSTALLATION WILL SERVE: RESIDENCE Q COMMERCIAL - may. ❑ OTHER <br /> N UNIBER OF LIVING UNITS: V., N UMBER OF BEDROOMS: <br /> NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPF./MFG CAPACITY <br /> ft OF COMPARTMENTS <br /> C] GREASE TRAP TYPE/MFG CAPACITY <br /> gal NOF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETONEARE.SI': WELL R FOUNDATION <br /> R PROPERTY LINER . <br /> ❑ LIFT STATION SLZE Tl'PE pF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEAl) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH UP LINES <br /> ft <br /> DISTANCE TO NEA REST WELL_ ft FOUNDATION ft PROPERTY LIKE - <br /> tt <br /> ❑ FILTER RED WmTH ft LENGTH fl DEPTH <br /> fi � - <br /> DISTANCETO NEAREST WELL R FOUNDATION R PROPERTY LINE <br /> ❑ MOUNDED WIDTHli <br /> ft LENGTII R DEPTH ST <br /> DISTANCE TO NEAREST WSIA- R FOUNUATION R PROPERTY LINE <br /> ❑ SUMPS WIDTHft J <br /> R LENGTH A DEPTH R � <br /> DISTANCE TO NEAREST WELL ft FOUNDATION <br /> R PROPERTY UNE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft peP7I€ <br /> DISTANCE TO NEAREST wEL.L R FOl?NDA77ON t <br /> Il PROPERTY LINE <br /> ❑ SEEPAGE PITS NUMBER y4'mT'H R <br /> fi DEPTH R <br /> DISTANCE I ONEA REST WELL ft FOUNDATION it PROPERTYLIFE <br /> 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 /> HNIN1 uim 4 HOUR ADVANCE NOTICE REQUIRED FOR INSPF.CT[ONS-PLEASE:CALL(209)953.7697 5 <br /> SIGNED � l._ TITLE'�'^:"��:'I r^, J'v�4�i,_ DATE - •-""5-'.. <br /> s } <br /> r I <br /> _ I <br /> j F <br /> In , <br /> ific <br /> U <br /> J <br /> u <br /> A <br /> DEPARTMENT US}ONLY <br /> Application Accepted B4' Date d t+7�It'1 { <br /> !- Area Employee Me <br /> Final Inspection By Date ❑ $pECIAL PERMIT-Approved by ' <br /> Character of Soil to Depth of 3 FI Pirsomp Snir Character: <br /> COMMENTS <br /> P£ SC Received -Checldll Amaunt Permit/ <br /> Code INFO By Cash Re "'d <br /> Date Invoice q Permit ID# <br /> Service rm oast# <br /> 42-02-001 <br /> 12;22,2003 ONSITF,WASTEWATER PERMIT <br />