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7 v ONSITE WAST\``�J'VATER TREATMENT SYST'_fS PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DE}RICrMENT 304 E WEBER A%T-w 3""FL-STOCKTON CA 95202 - (209)468.3420 NON-REFUNDABLE PERMIT p�(� CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM.DATE ISSUED / JOB ADDRESS I ! II Lam(' Y E-0 CITY/ZIP CROSS STREET /i:f-fes �0 APN Z(J / lJ J/ > � fir'.! /PARCEL SIZE �`Y //�� Ln''�� OWNERNAME W��2� �Ir'.OL'Y� //�7n PHONE 6<,^O �Yo rbi- _ 5✓n�i7 OWNER ADDRESS ) Imo/ I7�rAA�1��-7 ' r"" - CITY/STATE/ZIP I ='/"f/A//4 CONTRACTOR � I LG-(.�/e,� 2 /r�L/��/�LJ PHONE L 2r.�/✓ 3,4 // -�C•'�f CONTRACTOR ADDRESS �• G�• �3L/J� /'�UU CITY/STATE/ZIP LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: H GEOGRAPHICAL INFORMATION: Coordinates X PERC TEST(S) NUMBER -2- LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION ❑ Rr.PADUADDITION ❑ ENGINEER DESIGNED/ALTENNATIVE ❑ REPLACEMENT ❑ DESTRUCT'ION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: O SEPTIC TANK TYPF/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ PING TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION H PROPERTY LINE R ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES it DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R ❑ FILTER BED WIDTH H LENGTH tt DEPTH ti DISTANCE TO NEAREST WELL III FOUNDATION Il PROPERTY LINE ft ❑ MOUNDED WIDTH H LENGTH B DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL III FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS WIDTH R LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE 0 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 21 H UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED. TITLE / JLI C>fit DATE /gip { r L a t JX- r F- IL , T e- •f v J7Z I A e , s O v vs , 3 a- r . ) ' PARTME ON ' Application Accepted By ate Area t'y�� / Employee IDN__ Final Inspection By Date D ❑ SPECIAL P RMIT-Approved by Character of Soil to th o1`3 F: Pit/Sump Soil Character: COMMENTS g z PE SC Receivedheck#/ Amount Permit/ / I Code INFO B s Remitted Date Service Request k Invoice# Permit ID# /�(P7 n3 oc qG. 42-01-010 \ 17/2/02 ONSITE WASTEWATER PERMIT