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_ (7,j <br /> ONSITE WASWE TER TREATMENT SYSTEI ERMIT <br /> SAN JOAQUiN COUNTY ENVIRONMENTAL HEALTH DEPARTMEN"r <br /> 304 E WEBER AvE -3""'FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT ^ �CAL�1, 09 953-7697 FOR C <br /> INSPETiONti EXPIRES 1 YEAR FROM DAre ISSUED <br /> — <br /> JOB ADDRESS t*I <br /> IAPN 69O LE11- ALI. elite >G <br /> CROSS STREF.i' <br /> v <br /> l� u r i <br /> z <br /> OWNER NAME ��`-•`�`^-- { PH N'1. <br /> OWNERADDRESS - CITYISTATEIZIP - <br /> _ r1 l I �1I <br /> CONTRACTOR PHONE t� -�Vit• + 1`.�' <br /> J. (. CIT\'IS'E'ATE)"/.IP L <br /> -CONTRACTOR ADDRESS _j <br /> Y- LICENSE C-42 ❑C-36 OTHER NUMBER �cr ` EXPIRATION DATE <br /> WATER TABLE DEP I'll'. it GEOGRAPHICAL INFORMATION: Coordinates X 1 <br /> ❑ PERC TEST N BUILDING PERMIT# LAND U5E APPLICATION# <br /> TYPE OF WORK: i 4 NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED 1ALTERN'ATIVE <br /> REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE CONINIF.RCiAI: © OTHER <br /> NUMBER OF LIVING UNITS: / NUMBER OF B DROONIS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYI+E/MFG 1.r9i,!IC f�_ /S' �cc'1 CAPACITY /, 'l gal 9 OF COMPARTMENIS —Y <br /> ❑ CREASE TRAP TYPEIMFG r�7 CAPACITY gal #OF COMPARTMENTS <br /> ❑ <br /> PKC.TX PLANT DISI'ANCE'1'O NEAREST: WEI,I. / 75 it FOUNDATION L ` fl PROPERTY LINE Ger' fl <br /> ❑ LIFT STATION SI%E: TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Pf LEACH LINES ❑ LEACHING CHAMBERS #OF LINES -7 LENGTH OF LINES <br /> - - DISTANCE TO NEAREST WELL l S _ ft FOUNDATION c-_-)CI ft PROPERTY LINE <br /> ❑ FILTER BED WIDTH ft LENGTH f't DI:PT1i J1 <br /> DISTANCE.TO NEARVST WELL 1l FOUNDATiON 11 PROPFRTY LINE ft <br /> ❑ MOUNDED )VurrD ft LENcrrIl ti DF:PrII fl <br /> DISEANCE'LO NEAREST WfLI, it FOUNDATION 11 PROPERTY LINK Il <br /> ❑ SUMPS WIDTH .R LENGTH 11 IXI,1if <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 1t PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DIi P'fli It <br /> DISTANCE:'PO NEAREST Wlil,l. R E[1tINDA'IInN ft PROVERTY LINT: It <br /> SEEPAGE: PITS NuroBER [ WurrD ' Il DI:P'nl c It <br /> DIRI•AN(.E'FU NEAREST WIiI.I. �? 11 FOUNDATION .i C1 fl PROPWly I.INE C? It <br /> I HEREBY CERTIFYTHAT 1 HAVE PREPAREI)TUIS APPLICATION AND THE:NVORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COU:N'I'Y <br /> ORDINANCES,STATP,I,AWS AND RULES AND REGLILA'1'ION'ti OI>SAN.IOAQLIIN COUNTY. --� <br /> MININIUMM224 W UR ADl' NCE NOI ICP;REQUIRED FOR INSPECT[ONS-PfI.EAtiE CAi,I,S2f111 y53 lhy7 <br /> SIGNED ,/i"-, /_� 111 TITLE -, .+.�/ DALE <br /> l <br />�. � <br /> _ l <br /> I � <br /> j <br /> 1 <br /> x <br /> Qi JIN C <br /> - <br /> �,,,.rr,...,,,,,r�. ,�„.�-- _ r..:�_.�_-►•,.., ,.. -�.- : .r.',.e Derr..��,:.. -.�-�.�-:. .s . --—,� N.. l <br /> DEPARTME1 ,'E NLY <br /> Application Accepted Bp _ �` Date J�L� Area employee ID# 53 <br /> Final Inspection BN 4" Date ❑ SPE'. -[AL PERMIT-Approved by <br /> Cliaracier of Soil to Dcptli of 3 Ft: C Pit/Sultlp Soil Clraracler: <br /> -^COMMENTS G? 6,_r6VV1 <br /> PE SC Received c Amount ate i Permit! <br /> B <br /> Code INFO Cas Remitted Service Re nest# d <br /> J q <br /> 5 _ _ <br /> Izrzz:nn_ - <br /> I <br />