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SAN JOAQUIN COUNTY EONSME'IITELWA, EEWATER TREATMENT WYf ^t.M PERMI ,,B <br /> NON-REFUNDABLE PERMIT CALL( 953-7697 FOR INSPECTIONS EXPI S 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS g7 <br /> -Q CITY/ZIP /� 2 <br /> CROSS STREET �+ 'a. Al �• O APNy(7C,- i4O- 26 PARCEL SIZE tz- 12 aC • <br /> r� F� '(73 <br /> / / O <br /> OWNERNAME //�� V �,,^^� I_ PHONE C73 --7 <br /> OWNER ADDRESS V 10 � --e- � � Y/STATE/ZIP (7 <br /> CONTRACTOR 14�7 3 PHONE / 6a- r <br /> 1MW Ir <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: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LINE ft <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 ft PROPERTY LINE R <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LME ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH 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 R <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft ^ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft i-4��11a4 <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY D <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HO R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-P,EASE CALL(209)953-7697 m <br /> SIGNED ,,. TITLE DATE f <br /> IQ 4 �✓-.LrN JiN�O 0�V J �Jn"l� l <br /> �1 <br /> -TT11 3 d •moi v _ m <br /> E E £ <br /> p o w a 3 to yfjyn�`dy�,, �• ro - 7 Cr a <br /> PAYMENT <br /> RECEIVED <br /> 3 S� v <br /> ° AUG 16 2004 <br /> -- - <br /> r----�-PART�"EN'TTG O �CY' --- - - - -- -- - --- — <br /> Application Accepted By Date I Area 02/ Employee ID# GI tj j <br /> Final Inspection By - i - Date j--7ti-G,� 13 SPECIAL RMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS - .kx- +.I..i f5 • /45t,C 4ZLC!-=/?�ZQ./ <br /> s7 /L#Z u9cf f' �v�rxKFs7t'� f?'a�li! 4Y o �Jc-&Rc lJgl rY&7-'fi!/sw7 4 d1/T� f�3N/iT <br /> 5 �«� « <�` r� rot, Lh i�/ - �>nf= • "amu.,'. <br /> PE SC Received CkUW Amount <br /> Data Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> J(2-z.l GTS w 39.00 In <br /> 42-02-001 /�M -'CLJ/i 7 ��f•` :5 �, <br /> 12/222003 STEWATER PERMIT <br />