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his w 14;-1 <br /> � ������ ONSITE WASI%dWATERTENT SYS'1,�14 <br /> SA7-J AQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3X0 FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS ^EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESS -)AM-'T- F.NA ni- 1 �r L.4/ZF If-0*6 CITY/ZIP /TIii.I1An.XfTgS ZZ� v' <br /> CROSS STREET APN ,e&�D� PARCEL SIZE a <br /> p <br /> MAXrr���..,,'� � �p p <br /> OWNER NAME 1"AX 17Yd.V- PHONEW9 ZV, <br /> OWNERADDRESS LIJ'!/'S,- AOR-1557' 14bLC ao)pnD CITY/STATE/ZIP LABw 9:l ZZ o <br /> CONTRACTOR — PHONE 204 -23'Y-7-]Q7 <br /> CONTRACTOR ADDRESS '- - T <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> r�grPERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> elt- <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION lA <br /> INSTALLATION WILL SERVE: O RESIDENCE ❑ COMMERCIAL - ❑ OTHER \ <br /> NUMBEROF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS V� <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LME ft (J <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH it \ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R s,> <br /> Ll sumps WIDTH R LENGTH ft DEPTH ft Iv <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R a <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ SEEPAGEPITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft <br /> 1 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 /> MINIMUM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLEDATE <br /> SAN JOAQUIN COUNTY LINE & grn.licetion# _ <br /> CENTERLINE DRY CREEK v on <br /> I L <br /> t r <br /> I� 1 <br /> I f� PCL 24 <br /> CL.st I PCL 3* C L;47(k P <br /> -C LV — <br /> Xr <br /> W)flat[Anl710CL <br /> ». ,�,,.iM d� �.n...d Wu-U� M •' J0115 <br /> lanrJerefo � 11 <br /> SAN J , <br /> UNSUAVEYED e: 1 ��i�x�p <br /> REMAINDER <br /> DEPARTMENT USE ONLY �r _ <br /> Application Accepted By Date 1 J Area ' Employee ID# <br /> ❑ <br /> Final Inspection By Date 1 J SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pi Sump Soil Cheter: 6 f. <br /> COMMENTS Pzyc _'Csl G(d)1c c t (L L I C<G CUs ') �v �l �y+ /V <br /> v{aAarfiesf(clew ra 2HKs�i 3c I vS MN. <br /> PE Sc Received Che Anlibunt Permllt <br /> Code INFO B Cash Remitted -Date Service Re uest# IDvolce# Permit ID# <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />