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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> F-,.. <br /> JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-316 FL-STOCKTON CA 95202 -(209)465-3420 <br /> NON-REF UNDAB/L/E PERMIT y 1 f=CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> I, oB ADORES' I LF 100 � � a 1' V11: � 1-a V1 C1TY1ZIP <br /> 11 �1 1 r K� PARCEL SIZE -� Y - V <br /> CROS'STREET I�i.J''II U (ii+I APN 1 �..Il - ; 1 C_ - .� 31-�`��._ o <br /> OWNER NAME Mv- IrrcISYI -�` �L-�+ N3`-"�^ ..•PHONE <br /> WNER ADDRESS ` CITYISTATEJZIP <br /> kkkl,, <br /> rr^qf <br /> k-SONTRACFOR ll, 1� PHONE_�li <br /> CONTAACFUR ADDRESS �I _ _ - - ! I .:.a 1. CITVISTATEIZIP er. I <br /> LICENSE ❑C-02 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> I WATER TABLE DEPTH: fl GEOGRAPHICAL INFOILNATION: Coordinates X Yr <br /> I — PERCTEST # j-- BUILDING PERMIT# LAND USE APPLICATION# }`; E.i<r!'.:�� �-T-- <br /> TYPE <br /> -TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRlADDITION ❑ ENGINEER DESIGNED(ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> 4f`l K' <br /> INSTALLATION WILL SERVE: R RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMHER OF EMPLOYEES: <br /> I <br /> FE] SEPTIC TANK TvrelMFc CAPACITY 921 #OF COMPARTMENTS <br /> 1 <br /> j ❑ CREASE TRAP TYPE/MFG CAPACITY gal NOF COMPARTMENYS <br /> h <br /> —U PKG TX PLANT DISTANCE TO NEAREST: WELL fl FOUNDATION ft PROPERTY L[NE ft <br /> IS <br /> FLI LIFT STATION SIZE TYPE OF PUMP 11SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS <br /> #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCETO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH f1 <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMP$ WIDTH ft LENOTH 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 fl FOUNDATION 0 PROPERTY LINE ft <br /> ff Q SEEPAGE PITS NDMBER WIDTH IL DEPTH ft <br />! DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> { 1 HEREBY CERTIFY THAT I HAVEPREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDI NANC£S,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 1N,I MUM 24 HOAR ADVANCE NO-1-1 IT'ICE REQUI REFOR INSPECTIONS-PLEASE CALL 1209)453-7697 <br /> ,l ow <br /> SIGNED TITLE ICS // r'; �t DATE <br /> i y f f'C..' �J '�. .- 1 <br /> 4F 1 <br /> S � <br /> + r <br /> J <br /> r <br /> ` I 3 <br /> tic <br /> ily <br /> f _ <br /> I <br /> DEPARTMENT 115F�ONI,. c,1 <br /> Application Accepted By Y _.L (/;� C—._ Deie j/fE �s Area -2-1 Z Employee lDtk C) <br /> Final Inspection By <br /> Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit(Sump Sail Character: <br /> i <br /> y COMMENTS <br /> III _ PE 5C Received Check#! Amount Permit! <br /> P <br /> invoice# it[D# / <br /> Code [NPO B ash Remitted Date Service Re uest# erm !/ <br /> 4 <br /> 1 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> � w <br /> f 12122,2003 <br /> f <br />