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L <br /> LONSITE WASTEWATER TREATMENT SYSTEM PERJ Mi �3m <br /> SANJOAQL IN Cot\1'1'EN\IRONMEYTALHFALTII DEPaRrHE%r AWE W'ESERASE-3XO FL-STOCKY 9�5�1 <br /> NON-REFLINDABLE PERMIT CALL(209)953-7697 FOR I NSPECTIONS EXP! S I S EAR FROM DATE ISSUED <br /> LJOB ADDRESS 1ITY21P <br /> CROSS STREET �` se/�� aym 'Z � O APN CJ�L" /\]C'-2p PARc"SCEE IZ 12 4c <br /> OIVNER NAME /�,J/�^�)V/ IN V .� I /NAV PHONE C73 --7L,`Y/ <br /> OWNER ADDRESS V JJ V I G e- ISTATEIZIP 1) <br /> CONTRACTOR ewc <br /> PHONE / 6a r <br /> CONTRACTORADDRESR JjlWp� CITY/STATFJZIP <br /> LLICENSE 0 C4 LI C-36 OTHER NUMBER MPIRATIONDATE <br /> WATERTABLFDEPTH: fl GEOGMPHICALINFORMATION: Coordinates X Y <br /> ❑ PERC TEST p BUILDING PERMIT <br /> # LAND USE APPLICATION# <br /> j TYPE OF WORK: O NEW INSTALLATION ❑ REPAIH/ADDITION ❑ £NGINEERDESIENED/ALTERNIV <br /> ATE <br /> L ❑ REPLACEMENT DES RO ION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNRB: NUAEBEROF BEDROOMS: NUMBEROFEMPLOYEES: <br /> L ❑ SEPTICTANK TYPE/MFG CAPACITY pi #OF COMPARTMENTS <br /> ❑ GREASE TRAP TTPEIMFG CAPAC" Ral #OFCOMPARTMENTS <br /> ❑ PKG TX PLANT DIETANCETON"RESr: WELL R FOUNDATION R PROPERTY LME fl <br /> J LIRE STATION 512E TYPEOPPUMP ❑ SANDOILSEPARATOR(ENCLUBEDSYETEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF❑NEs LENGTHOFLINFS ft <br /> DISTANCETONGREST WELLR FOUNDATION R PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH tl <br /> DIETANCETO NEAREST WELL R FOUNDATION ft PROPERTY LME R <br /> ❑ MOUNDED WIDTH R LENGTH ft DEmI R f <br /> DISTANCEANANEAREAT WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WmTx B LENGTH R DEPTH R <br /> DISTANCE TO NEARPST WELL ft FOUNDATION fl FROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WEAR_ft LENGTH R DEPTH fl <br /> ` DISFANCETONEAREST WELL R PODNDATION fl PROPERTY LINE fl <br /> ❑ SEEPAGE PITS N.H.F. WmrH B DEPTH fi <br /> DIATANCE TO NEARM WELL R FOUNDATION ft PROPERTY LINE R <br /> L 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WI LI,BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> / MINIM UM 21 H0 ADVANCE NOTICE REQUI RED FOR INSPECTIONS-PEASE CALL(209)9534697 <br /> SIGNED (I�Vt• yy , NI TITLE #7 DATE. cf�� <br /> Pay �a <br /> L PAYMENT <br /> ^• RECEIVED <br /> I` �9 m �_ AUG 16 2004 <br /> m DO <br /> v <br /> '+ DEPARTMENT U5EOHLV I/C� <br /> L Application AuePted By• Dale 8 / Area 2/ EmpI.,=IDN ON <br /> � <br /> Final insptttian J <br /> By "' [ ^, - Date —zs-[ ❑ SPECIAL IT- <br /> RMAppmved by <br /> Character of Soil to Dep,pGFI FI: PIUSump S.11 Cl...Ater: <br /> Y COMMENTSc �-'= •�>.�.�'-L, .! ,'Fr w:`ls /�-7!C4ZLCC/'�I'2LSyC y:;'_ <br /> 1 I;%'411-A"- �ICa l</3' >1 ! Sc-z v R-lcF i JlY-ST,1'ryflJ /A/7� '�f Air-f?331/r'; <br /> -s' rc l# xes-�L^- e -t...1-F3L i 1/i - Z/i2r?r` �G rsts' •.ik <br /> PE SC Receivetl C ArRaRnl II Dare PermfU InvRiee# Permit lDp <br /> Code INFD B Cnh RemiMd Service Re ueeCN <br /> /3NCP1. 11 « //R S.Lc.`'.S+ldS �A J STEWATER PERMIT <br />