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ONSITE VSTEWATER TREATMENT S`'{;� (',' 7 <br /> ,� TEM PERMIT '160 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL H H DEPARTMENT 304 E W^AVE -3"°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS 20 M. Ilewy ,r-rCITY/ZIP IvAliw A/ L <br /> CROSS STREET APN ©f3 -030--44 PARCEL SIZE f17- Ac- p <br /> ��(( �[/j <br /> OWNER NAME �T PHONE -fig ry�'�� / I per+ <br /> OWNERADDRESS If 2-0 N' XleW/ TT RD.4D CITY/ TATE/ZIP1—/I✓DF/� <br /> CONTRACTOR L 7- LA PHONE V !/ <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP LU A rJ <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: vL3V ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEWINSTALLATION ❑ REPAUVADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL It FOUNDATION R PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft 5L- <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED wurrx ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH �ft <br /> DISTANCE TO NEAREST 'WELL ft FOUNDATION ft PROPERTY LINE _ft <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH R <br /> DISTANCETONEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ;U�ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE/ ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH CY R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIFE <br /> I HERE7CEFY THAT I HAV REPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> F NCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINI ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE 45WN9eft DATE 7- -D <br /> IJPL <br /> C U <br /> NVR T <br /> OA I� Ll- <br /> 7 <br /> S s <br /> DEPARTMENT US ONL Cod <br /> Application Acc edjq3 <br /> Dete f O Area .L Employee ID# .J 1 <br /> Final lnspectio By Date �" �CYJ�i ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil t: PRISump Soil Character: <br /> COMMENTS <br /> PE SCReceived hecldl/ Amon t Date P rmiU Invoice# Per ID# <br /> Code In'O B as Re." Service Re nest# <br /> 7 c $ os <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 1222/2003 �-�2 GU <br />