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ONSITE WAS? ,NATER TREATMENT SYST j PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH Dy,IRTMENT 3 f g 17, 6t0 ( 304 E WEBER.`•3 PL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL(209))953-7697 FOR INSPECTIONS EX^PI_RES'I YEAR FROM DATE ISSUED JOB ADDRESS 7,3o 7*5 Fe"sfQf CIL CITY/ZIP Y2-1 Q ,�� ^1 'J y1 A CROSS STREET //Ct�11-f}/�J /� rN O „ ' APN PARCEL SIZE -[ / 141" -41 OWNERNAME fr A2f ty'�1N/A N,,J.T Z.-, IAJ C - oy PHONE OWNER ADDRESS q CITY/STATE/ZIP [� /� �/ -fJ` CONTRACTOR I�&4ry HL`D&4,2— / /PHONE 7 LIg”-(/U3�ff CONTRACTOR ADDRESS Zb yg 5 /N!'��TL-OLS CITY/$TATE/ZIP 7 / v� 7 7 (moi 5 d LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLEDE"H: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST(S) NUMBER I LAND USE APPLICATION# _(.[ d0^ 0 TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAnVADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION T INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER "S NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: /6 ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS fd ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS in ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ti ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft 7 CI sumps WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION PROPERTY LINE fl ❑ DISPOSAL PONDS WIDTH It LENGTH it DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS WIDTH R LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, ST TE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 24 O R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED ' TITLE GJ61AIM-S-1`— DATE - - - - 1- - - - - - - - - - -q- - -1 1 - Y 1. 4w lox um ao I S sa-- s� I-s.�l-- - - '..t•. I ON EN - r _` S UNE PSS v1 oN K KJELDSEN <•"'•ne•woo^w. owm "os S SINNOCK zun r..e.n.0 o."e, ao., accK nx NINEUK SITE PLAN o E air•H.. rw loge m...ru� APN 245-260-08 14.77 AC. J0B MO' 1efe'oos.o suds s a -DEP Application Accepted By V`WOI+'"r'V Date=-C j % Area I Employee ID# Final Inspection By Date C ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth Ft: PIUSump Soil Character: COMMENTS ~ y� '�L 3 ' PE SC4Received Check# Amount Date Permit/ Invoice# Permit ID# Code Ingo ash Remitted Service Request# 22.2 52 Q 34 26 & 3D 42-01-ODI 12/2/02 ONSITE WASTEWATER PERMIT