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ONSITE WA)a EWATER TREATMENT SYI,,.E;M PERMIT -,"�,AQ1S^''++� r� r>. ' " SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE -3"°FL-STOCKTON 952U2I 8w Iw. LL `2�9)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS -5 ((-en Ali I CITU/ZIP Y±oGrS.fjJn m CROSS STREET I / fIA y APN (e-7 — /—TU—tC% y ''['� PARCEL SIZE OWNER NAME T64A I> I �j lMb eco1 PHONE OWNER ADDRESS _) Cr"tKt CITY/STATE/ZIP ))��(�-� yy C� s K L CONTRACTOR r 4 �L.J✓'r L PNONE —17(,R^,T p(v CONTRACTOR ADDRESS CITY/STATE/ZIP al4d LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE A 5, WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT#, LAND USE APPLICATION# — TYPE OF WORK: If NEW INSTALLATION REPAIRIADDITION ❑ ENGINEER DESIGNF,D/ALTERNATIVE 9 REPLACEMENT L-F-AC K F+4..(.Q ❑ DESTRUCTION INSTALLATION WILL SERVE: d-kESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBEROFLIVING UNITS: I NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS _ ❑ GREASE TRAP 7YPEIMFG CAPACITY gal #OF COMPARTMENTS ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATIO fl PROPE E ft L3LIFTSTATION SIZE UMP AN 'OIL SEPARATO"WLOSEDSYMM) ff 'LEACH LINES LE G BERS of L14Es ,• r tENGTH OF LINES `i0 ft DIST ETONE T 'LL lnnl ft FOUNDAT to I ft PROPERTY LINE for R 6 ❑ FILTER BED WID ft I-I NOI-H ft DEPTH ft DIST CET t REST 4'ELI- UNDATION H PROPERTY LINE ft LI MOUNDED WRIT ft LL`6TH ft DEPTH ft DpfAN T% BAREST W'fll. ft FOUNDATION ft PROPERTY LINE R ❑ SUMPS WID -ENGTH ft DEPTH $ C DISTA TO NEAREST ELL ft FOUNDATION ft PROPERTY LINE R ❑ DISPOSAL PONDS ft LENGTH ft DEPTH ft TSTA -AREST WELL ft FOUNDATION it PROPERTY LINE ft Q,-'SEEPAGE PITS NIIMB WIDTH (/tf It DEPTH r�S f ft tjc DIS TO NEAREST WELL ft FOUNDATION In 3 ft PROPERTY LINE In( ft (h _n I HEREBY CERTIFY THAT I 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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED 1 -- J TITLE �'c]IL'NCL{br S DATE N U U F�'2 b o w n� w, w0 C �_ ',clo Ara boli D r2' IVA'7A- !LOAD .;OhC4, H N SANNVIRM" — — — — — — - - — — — —.{' — — — -- — -- --HEAL#!DE- Y r --o aw W W' Q 0 3SOOH\\ -X3 NaYH AYH/dOHS "X3 , I u w,g i I I Yx � � N 3,t>x36• R-ter---t w W LL) I Irrs .r�'t I z J z ao } O Ld ® (� i iJ� ISI' h`i $ g zoo "'� O'_ I I G $o a < InUQ 1 w w� igw Q. Its - o� y5D xz4, * xoCL a w a w OW `< Cif V) a' -- (L Application Accepted By �.%�-�----- Date / O Area Employee ID# Final Inspection By Dale 07 ❑ SPECIAL PERMIT-Approved by Character of Soil to pth of 3117t; Pit/Sump Soil Character: COMMENTS N84J LOT ill= LBS ^ted . )EEi ccA7ZG/J OF FtEL-4 TT AE t4u-4 L1Ji T-H ) b.07' i-1 -,e .4 P*---O ue-L- - wl LJe- e. sna u 1pckw }4 .57-24-7C.J 7V V ( A&t :0 •• n PE SC Received Chec Amount Date Permit/ Invoice# Permit lD# Code INFO B ash Remitted Service Request# 42.io (1-T Gr— � � 3 2-3v E-V p 4q.P-0 42-02-WI //-�// /D! c/r4r� /p'e �/T'/xt fy />u- , 2-s0'o 12/22/2003 '!7! �(/� pyf � / / / .k ONSITE WASTEWATER PERMIT �;••��i."P. l[Ywrn