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ONSITE WAS'` WATER TREATMENT SYST""A PERMIT SCANNED <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVL'-340 FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB AE DDRESS 3 S- W I CITY/ZIP �, ✓/i LA <br /> z CROSS STREET j w V 4f r APN - 2-0-17 PARCEL SIZE <br /> s C <br /> /�/ o <br /> OWNER NAME 1 i(A� f ( ! PHONE <br /> 5 �r `f f5.z-36 n <br /> OWNER ADDRESS GW CITY/STATE/Z[P a <br /> CONTRACTOR ame PHONE .20I- e r L'04aZ <br /> li <br /> CONTRACTOR ADDRESS <br /> P CITY/STATE/ZIP <br /> LICENSF ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOCRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION#_/,4 -5 <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINFER DFSICNED/ALTERNATIVE <br /> €� ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> E NUMBER OF LIVINC UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> I ❑ CREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES R <br /> k DISTANCE TO NEAREST WELL f[ FOUNDATION ft PROPERTY LINE ft <br /> k ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft V <br /> DISTANCE TO NEAREST WELL ft FOUNDATIONft PROPERTY LINE <br /> ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH ft <br /> i <br /> DISTANCE TONEAREST WELL ft- FOUNDATION ft PROPERTY LINE $ <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> !� DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ^f <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> ij DVANCF.NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNS TITLEDATE <br /> f <br /> f <br /> i <br /> Hoco <br /> 1 i 2T <br /> El PA CEL 4 <br /> R7AL TD <br /> �� ARAM c 'N19 2.0 ACRES f <br /> . <br /> VIED T,7 eE-y FSR..SYE Cc R6zOf.Y.TEU <br /> f7LLUCAT� S' <br /> VIE <br /> SIJ <br /> rklpCx rtn � A4AINO R <br /> fA �o <br /> CW!Z� ,. za hrlL �ot�,cr4� <br /> PARCCL i s 2.n.Acres - aR'lsf9- n i h <br /> Lt1I. _ <br /> 7.) <br /> ' fFl4L£ _ - <br /> .. ..^5 FRI�£Lfi�4 <br /> Jg ,,; <br /> EE NNTY <br /> Lii ATH DE A EDIT <br /> DEPARTMENT U E ONLY <br /> Applicl tion Accepted By } Date Y+' Z'S Area Employee ID# <br /> Final Inspection By T Date ❑ SPECIAL PERMIT-Approved 6y <br /> Character of Soil to Depth ty 3t: Pit/Sump Soil Character-,_���/��/�� ��� �C.� .5�,' , S <br /> S <br /> i <br /> E; <br /> PE SC Received Check#! Amount Date Permit! Invoice# Permit ID# <br /> Code INFO B s emitted Service Request# <br /> 10 372.,0 DS $COD (_4 <br /> 42-02-061 ONSITE WASTEWATER PERMIT <br /> 12/22/2603 <br /> e; I <br />