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rI& WASP'T,WATER TREATMENT St' .. )—,.. -PERMIT <br /> -' SANS;„ N�COUI>ZTY_EN -:I'vIENTAL HEALTH i..:rARTMENT 304 E WEBERy f-3w6 FL7,STOCKTON CA 95202 - (2D9�)4u68`-3420 <br /> ;,ON-REFUNDABLE PERMIT 'CALL(209)953-7697 FOR INSPECTIONS EXPIRES l YEAR FROM DATE)SSUED <br /> JOB ADDRESS,. I '76 _ __t�� � t CITYIZIP �t� - <br /> :, SCI r7J <br /> CROSS STREET f _ APN 3 PARCEL SIZE �!7 � <br /> OWNER NAME, _.j f 1[ _ _05��_ I'h O —---- PNONE . <br /> V <br /> ! �li rr , <br /> OWNER,ADDRESS "i G r fl*_Ir �1[j T CITVISTATEIZIP <br /> CONTRACTOR Fl�f_9ulwg5 .IIID J-" ny, -Tri G , PHONE _r;;Z0'0-44:z Z2&:6 jC dd� u <br /> CONTRACTOR ADDRESS �S� ,'8'q1 5T/-74n/C7 ( Ar 4 CITYISTATEIZIP <br /> LICENSE ❑C•42 ❑C-36 OTHER T 6 NUMBER 641-741 EXPIRATION DATyEy�J7 <br /> WATER TABLE DEPTH: oft GEOGRAPHICAL INFORMATION: Coordinates X Y ate' <br /> ❑ PERC TEST(S) NUMBER LAND USE APPI°ICATIW ' <br /> TYPE OF WORK: .IR NEW INSTALLATION ❑ REPAIR/ADDITION Ll ENGINEERDES(6N DIALTERIVATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE . COMMERCIAL ❑ OTHER m <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS l�- <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMIENTS <br /> © PKG TX PLANT DISTANCE TO NEAREST: WELL_ ft FOUNDATION ft PROPERTY LINE:; r1 R <br /> ❑ LIFT STATION SIZE TYPE OF.PUMP ❑ SAND OIL"SEPARATOR(ENCLOSED SYSTEM) <br /> I <br /> 14 LEACH LINES ❑ LEACHING CHAMBERS #of 1,[N£5LENGTH.pF LINES �cd ft <br /> i4 DISTANCE TO NEAREST, WELL azo d^ ft FOUNDATION 45 ft PROPERTY LINE :,. fiZ <br /> ❑ FILTER BED WIDTH ft -LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION- ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH R'. DEPTH i'ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft., DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS WIDTH oZ .'7 f ft LENGTH ft DEPTH Z t ft <br /> DISTANCE TO NEAREST WELL �7 ft FOUNDATION �5 ft PROPERTY LINE '?Z(' � "`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 /> � MIMNM <br /> HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS--PLEASE CALL(209)953-7697 <br /> SIGNED TITLIi . 'n y DATE <br /> ------- <br /> E,f15T1Nf!�-51'CM•Fl^I,rf 1 � E 1-� '" <br /> I' ; I <br /> . I ry•1 <br /> 1I I <br /> . ... <br /> `tl�' ---aT T raecr m ulerrKs'+• �� {- <br /> r L,r•_� ` 1�. su+l Y.ar sear 4,. <br /> - <br /> s•� <br /> Ld TV <br /> W41f <br /> p1 <br /> mj .•O LTN <br /> 0 ® RCwl YO CMGiR'LTIQV. rcG 1_ I , <br /> s.co• - Isco o-+tusl sync wrc a •, -r' <br /> I •• Ib+/,IT G.O_•�^0.l+�.. G � rctlON. 1e \ �` £ <br /> 5b L./.-LGGI.1:lAC •.m n M L.I.-L LIIE _ <br /> I' <br /> Lrre <br /> —•'I'•-. <br /> WrSri "iervw <br /> I , <br /> Ie1Xa01I P aenr. j_ <br /> ;mg' <br /> 7 D HENT SE' <br /> _ �:— EPAR'I' <br /> j Application Accepte -= Date d Area Employee ID# F/ <br /> h ------ i tal',Sttsp i tion: -- . _. c c fKal spate �r e, El SPECIlkL' Ow T Approved li`y ' <br /> �.` I r•, ✓ ij.: Y II,.,� : .. -e.as .r: l a .!'_1' i ,i,(til f-,,:z <br /> Character of Soil to Depth of 3 Ft: PIt7ilmp Soil ara2ter. <br /> COMMENTS i I ' J <br /> q�- l.et•a, «f' f2z IF:k` .3`�' ..sf)'.1 �' IE #3'1 gtl�M- 3..�_;J.r _d. r." -^.,`t ' <br /> P.E' SC Received c Amount 'PermiU' <br /> Date voice "Per It <br /> Code INFO B ash Remitted Service Request# <br /> 4231 ti - 9� ; rte_ <br /> aw- <br /> ONSITE'W ASTEW A <br /> 4,s t"4' D TE1t PERMIT <br /> 212102 <br /> 6' <br />