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t1� ONSITE WASTEWATER TREATMEl T SYSTEM}PERMIT <br /> I SAN JOAQUIN COUNTY ENV]RONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-31°FL-STOCKTON CA 95202 -(209)468-3420 <br /> I NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 11-41— f'� t� l_I N'�i..t\-t 1�".t� <br /> - CROSS STREET i'• ? E I <br /> ' APN l I;ti- Ll C f-':e.? PARCELSIZE ` r 'A <br /> OWNER NAME _ ! ...�',-I-7.1• 1i. <br /> PHONE <br /> r <br /> OwNERADDRESS '{ r_.{ +. r �- P'y.- CITYISTATE/ZIP '+1, .,, l { L, "1 4 r <br /> CONTRACTOR rq1_.t i .., <br /> CONTRACTOR ADDRESS_i�r'Z `:- <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER <br /> EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPH[CAL INFORMATION: Coordinates X <br /> V <br /> tLd PERC TEST # i BUILDING PERMIT# LAND USE APPLICATION#I'�•�'�- _5 I'{" <br /> TYPE OF WORK: ❑ NEw INSTALLATION ❑ REPAIRIADDITIDN <br /> ❑ ENGINEER DESIGNED lALTERNAT[YE ` <br /> U REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL { <br /> II ❑ OTHER <br /> t., NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> L3GREASE TRAP TYPE/MFG CAPACITY, gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TU NEAREST: WELL fl FOUNDATION ft PROPERTY LINE ' <br /> ftr <br /> ❑ <br /> LIFT STATION SIZE TYPE OF PUMP - ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Q LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> DESTANCE TO NEAREST - WELL• ft FOUNDATION ft PROPERTY LINE It <br /> ❑ FILTER BED -WIDTH i�:� ft LENGTH R DEPTH ft <br /> f - ...y DISTANCE TO NEARESC - aWELL fl FOUNDATION R PROPERTY LINE � ft <br /> ❑ MOUNDED s .,WIDTH ft LENGTH - ft DEPTH [ ft <br /> DISTANCE TO NEAREST ION WELL �- ft FOUNDAT <br /> r A R PROPERTY LINE R I <br /> 't C� SUMPS 'WIDTH k K ft'� LENGTH -`i- ft DEPTH <br /> ft <br /> �.'.\. ., WELL `]i R FOUNDATION - _ . R <br /> ` -+ DESTANCETONEAREST _ - <br /> R PRDPERTY LINE <br /> �. r❑ DISPOSAL PONDS Wloi'H ft LENGTH ! R D£Pix t ' ` <br /> . DISTANCETOINERC <br /> AEsr WE R <br /> LL e ft FOUNDATION R_ 'PROPERTY LINE ] ft <br /> �s'..,_ ❑ SEEPAGE PITS NUMBER r' WIDTH <br /> , DEPTH , ft <br /> DISTANCE TO NEAR£Sft WEEL4. t' PROPEATY.LINE <br /> rk�� *�` } r`1' '-A l L '`+•rA 1 f. 'L,s- .r; ry,v FOUNDATION <br /> '�`I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THEW RK WILL RE DONE IN ACCORDANCE WITH RAN JOA UIN COUNTY <br /> Q <br /> ORDINANCESSTATES LAWSAND RULES AND REGULATIONS OP SAN JOAQUIN COUNTY <br /> j J, l{+M 4 HOUR ADVANC9 NOTICE REQUIRED FOR I VSPECTIONS,'RLEASF CALL(209)953;j <br /> ,7 �r <br /> �g)gr } TITLE ]t I ti f!f t i,1 p •M <br /> .r>•,t..t-..' �s n� ,�Y;�c 1 as'?ri+ ,t:,d sa�,ds �.,.< ;w Tda's`� sem, �-.-.Ia'm �.g� <br /> * �u <br /> `'ler "' .'. <br /> .............. <br /> i ;ye Sx4'. q6, ?,s* r g.� 22 'fir'23 <br /> !!' >'x`' 8' { �' ti �"" �' r�• 77-1 <br /> � �i � a I -° <br /> r Tr a I a" ]moi- ; r< 4K 27 26 <br /> 01-k,`' <br /> 176 <br /> s <br /> 4009AC. a ! txi X a i*- <br /> F <br /> rc $ <br /> a r + ?- TVI O M f- - +r <br /> E 7F <br /> q. i' i +�.i'? A ;#« <br /> FLl JK <br /> F <br /> DEPARTMENT US ON /V / <br /> Application Accepted By" (�; { Date. _ ( Ares Employee]D#' <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by-- <br /> Character of Soil to Depth of3 Ft: PiUSHmp Soil Character: <br /> COMMENTS <br /> I <br /> J! PE SC Received Checld€!/ Amount Permiti <br /> t. � Code INFO I BY 1-ZCffl-r- Remitted Date Service Re vest# Invoice# Permit ID# <br /> �"�. `' rr t-b .5 g 0r 1 <br /> y 2-02-0OI <br /> 12122!2003 ONSITE WASTEWATER PERMIT <br /> �+ 1 <br /> f <br />