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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3Y°PL-STOCKTON CA 95202-(2119)469-3420 <br /> NON-REPUNDAHLE PERM/IT CALL 209 953-7697 Fox INSPEcTH:NN EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESSLV "Y I/72,�n,-� CITYJZIP - <br /> CRoss STRET EAPN 20 y ~L�--3 C7 Z7- PARCELSIPE II.S gp <br /> 0".NAME _QKK F�oaEMPHONE CC <br /> OWNER ADORPS4 COVISTATEIZIP •^{�1_ YY'' <br /> COKTRACPOR PHONE - V -Z L <br /> CONTMCTORADDRCSS COVISTATEIZIP <br /> LICENSE 0C4 ❑C-36 ODIER NUMBER E%PIRATION DATC <br /> WATER TABLE DEPTH: R GEOGMRIICALINFORMAYION: CanNl..N. X V <br /> 13FERC TEST <br /> p BUILDING PERMIT LAND USE APPLICATION# <br /> TVPEOP WORK: NEWINSTALLATION ❑ REPAIWADDNION ❑ ENOINEERUMIONEWALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RP8IDENCE ❑ COMMERCIAL y) ❑ OTHER <br /> NUMBER OP LIVING UNTI'S: NUMSEROPBEDROOME: / NUMBEROFEMPLOVEES: <br /> 9 SEPTICTANK TrPFIMPG nf*n`/1 h CAPACITY I(e)/7O gal #OFCOWMWEN'TS� <br /> Q GREASETRAP TYPFJMFG CAPACITY pl #OFCOAIPARTMENB <br /> Q PKG TX PLANT DISTANCETONEAREET: WELLbL Q 0 ft FOUNDATION 5-10 ft PROPERTY LINE SQ R <br /> O LIFTSTATION SIPS TVP[OF PUMP ❑ SANDOE,sEPARATOR(ENCLOS¢DBVSTEM) <br /> LEACH LINER ❑ LEACHING CHAMBERS #OF LM¢9_ LENGTH OF LINES /00 R <br /> DLSTANCEEONEAREST WELL ,%An-ft FOUNDATION_ ft PROPERTY LINE Sp ft <br /> EI FILTER BED wurra ft LENGTH ft DEPTH ft <br /> DISEANCETONEARESI WELL _ft FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCETONP.AREST WELL R FOUNDATION R PROPERTY LME It <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WmvN R LENOTH ft DEPTH R , <br /> DISTANLETONEARESI WELL R FOUNDATION R PROPERTY LME ft <br /> O SEEPAGE PITS N.M. WIM R DEPTH R <br /> DISTANCE TO NEARPET WELL R FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CENTURY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE W WS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> UM AN ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(2M 53-]fi9] <br /> SIGNED • DATL 2-07.06 <br /> t <br /> `4 rEEs o <br /> n `y y mom- <br /> e <br /> y / -3E IT <br /> M <br /> N <br /> N 4 ` <br /> — — ..DEPARTMENT E LY <br /> AWknekB A—Pw BY <br /> PID.]ImpcHaa By qte D6 ❑ SPECIAL PERMIT-AppmvW by T <br /> Ch.tero(SaRagpIh.f3 U IN ump RB II C6anekT: <br /> COMMENTS <br /> i <br /> PE SC RtMveB Chep# Amu M Perm1U <br /> CMN INN, B Being Dek SeM.R uMN InvakeN PeTRd11W <br /> 41-02-001 ONSITE WASTEWATER PERMIT <br /> 12OL1000 <br />