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ONSITE WtwwfEWATER TRLAATMENT S k,.d EM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3"°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 59e�J �+� � CITY/ZIP r 5 <br /> CROSS STREET10 <br /> U GK � �Lee_T APN CY✓D-/ ,5-6 —d{e PARCEL SIZE/S�89 <br /> r o/ C <br /> OWNER NAME /)//a ran PHONE <br /> G <br /> OWNER ADDRESS e� 6 7/ CITV/STATE/ZIP 4 " Cl/��/mayd <br /> CONTRACTOR , �a- PHONE �J - <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ PL <br /> NEW INSTALLATION ❑ REPAIR/ADDITION LIENGINEER DESIGNED/ALTERNATIVE <br /> -REACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBEROFLIVING UNITS: "NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> li SEPTIC TANK TYPE/MFG � it/ CAPACITY 1� � Sal #OF COMPARTMENTS r� <br /> !❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION. ft PROPERTY LINE It <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 It FOUNDATION ft PROPERTY LINE ft <br /> FILTER BED WIDTH 24 R LENGTH Pkl ft DEPTH ?w 11 <br /> DISTANCE TO NEAREST WELL 4�U*_ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> © SUMPS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WiDTA ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> RDI AN S,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 1 24 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)953-7697 <br /> SIGNED TITLE &4;AQ/ DATE O <br /> W GRANT LINE RD. _ — I FT� <br /> •:a5f5lt + "w <br /> BAYAREA <br /> "i DESIGNS <br /> •t;.1 't.;.:*�� - - ..... � .DESICNCONSZILTAN[S <br /> I. `!�L`r„ .•?iP.},.. '\ NEWAR 04560 <br /> S 10.440.0300 Tal <br /> 510.353.0200 F.. <br /> "V \NN 250 ao6 <br /> . . 1 <br /> S\ <br /> 1 ` <br /> t �S <br /> . , / <br /> . . . . i .�. <br /> pwwnw.n.unes � /i <br /> DEPARTMEN. U ON - <br /> 9 <br /> Application AccepOpthofiiFt: <br /> Date Area f�YNI�id�ee ID# <br /> Final Inspection B Date ❑ SPECIAL IMTjXpp.Qd by <br /> Character of Soil tMUSH VSoil Character: <br /> COMMENTS01�0 top AU 14 ZU06 <br /> PON U <br /> MENTAL <br /> PE SC Received Chec Amoun[ Permitl <br /> Code INFO B Cash Remitted Date Service Re oast# In # Permit ID# <br /> 5 s 9 z u° IV 1416)-' <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />