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ONSITE WAS ;WATER TREATMENT SYS M PER SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH W6ARTMENT 304 E W EBER A E -3R°FL-STOCKTON CA 95202 - (209)468-3420 I.I. NON-REFUNDABLE PERMIT CALL(209)953-7 97 FOR INSPECTIONS EXPIRES t.YEAR FROM DATE ISSUED JOBADDRESS O O CITY/ZIP /J11/DEJIG--qq--��r9f5 23G y CROSS STREET / I N L 1Z✓A-D APN 1993 -OJO 'G b PARCEL SIZE ^` 0 O OWNERNAME 4,gm&D P,4AIIA61,(A - PHONE 97.5- µJ j1D- 9D2G �' / r OWNER ADDRESS 1 � A gFk / 7-r /�✓-•/ CITY/STATE/ZIP CONTRACTOR C 0 f, Af PHONE O 6 S✓�/`T�j CONTRACTOR ADDRESS CITY/STATE/ZIP fl PI-OGK LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WA ER TABLE DEPTII: 11 GEOGRAPHICALINFORMATION: Coordinates X Y Lff PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATIOI9#I 18;'' TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ `!ENOI3Y.D`E�S{.I^G�NED/ALTERNATIVE (V Ll REPLACEMENT ❑ DESTRUCTION TJ'= ^ Q INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL' ❑ OTxc '1`J` '`''''`-' NUMBER OF LIVING UNITS: E OR BEDROOM NUMBER P&EES:' ❑ SEPTIC TANK TYPE/MFG CA ACI D , gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG C ACRS'. gai,,� k0 TMENTS ❑ PKG TX PLANT DISI'ANCETO NEA ST: F UNDATION ft IHIPItb?AT-bbNI1 ' ft {�rwtni tnlT ❑ LIFT STATION SIZE YPE OF PUMP ❑ SAND OIL SEP 70R(ERN OSED SYSTEM) r El LEACH LINES 13 LEACHING C A BERS #OF LINES LENOTH�i13;X S NEST*df ' ft f1e DISTANCE TO NEAREST WELL R FOUNDATION ft 'f/3R0/ L R _ ElFILTER BED WIDTH R LENG H R DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION R PROP1.8�1'LlNxhf" ft ❑ MOUNDED WIDTH ft LENGTH R DEPTH '' R DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LONE' ft ❑ SUMPS WIDTH R LENGTH ft DEPTH--Z--'- ft DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE'- R - ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH! "" ft DISTANCE TO NEAREST WELL R FOUNDATION R Ii PROP TY LINE�ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH �. ._T.... ft DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LME' ft 1 HEREBY CE RFV THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE W,IANJOAQUIN COUNTY DINANCES,STATE LAWS AND RULES AND REGULATIONS OR SAN JOAQUIN COUNTY. 'EDT4"£. " MIN WHOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209�(9�9.J '('a SIGNED TI £2 DATE 1,3 V mmuEg - �r 5tM �a i E v, SkN o o i p T E T LidA {r' 1 s DEPARTMENT USE ONLY Application A" ted By / Date I ' 0 Area V._�pio�ID# '' 1 Final Inspection By - Date Y IT ❑ SPECIAL PERM1 p v'r b VJW- p{oidu : Y. Character of Soil to plh of 3 t: / Sump Soil Character: COMMENTS 'v16. . .. PE SC Received It Amount Dote Permit/ Invoice# Permit ID# Code INFO By Cash Remitted Service Request# 112zcr 3 \\ 42-02-001 ONSITE.WASTEWATER PERMIT 12/22/2003 --1.- -,.