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` ONSITE WASTEWATEI7 TATMENT SYSTEM PERMIT � / <br /> SAN JOAQUIN BOUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3°pFL-STOCKTON CA 95202 -(2DBIEIEL342O <br /> NON-MiUND BLE PERMIT CALL(209)9$3-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADBREss ,2 ` ".ASA- H( VUr I•CITY/21P -FynG CLIJc <br /> CROS65TREEF APN ✓ Of 3 PARCEL SIZEu"'5C aM <br /> ' <br /> O <br /> OWNER NAME Mr. Halt \1 Tu)ta PHONE <br /> OWNER ADDRESS CITY/STATPJZIP <br /> CONTRACTOR Neil 6, Il-(� PHONE , L <br /> CO Cf0 ADDRESS'loz I-ridusillal. 11M CITY/STATP.IZIP [ I <br /> LICENSE WC42 L3 C-36 OTHER r NUMBER EXPIRATION DATE ^ <br /> WATER TABLE DEFfH: ft GEOCRAPHICALINFORMATION: C"D[IDYtea X V- <br /> IA <br /> FERC TEST # BUILDING PERMIT# LAND USE APPLICATION# W v11 <br /> TYPE OF WORK: ❑ NEWINSTALWTION ❑ REPAIR/AIDTION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ EITHER <br /> NUMBER OF LIVING UNITS: NUMBEROFBEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPF/MFG CAPACITY gal #OF COMPARTMENTS M1T, <br /> ❑ GREASE TRAP TYMET CAPACITY Bal #OF COMPARTMENTS �J <br /> ❑ PKG TX PLANT DISTANCETONEARFST: WELL R FOUNDATION ft PROPERTY LINE R^ <br /> ❑ LIFT STATION sm TYPE OF Pump ❑ SANDOILSEPARATOR(ENCt DSYSTEM) j-- <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLINEs LENGTHOFLINES ft� <br /> DISTANCE TD NEAREST WELL R FOUNDATION ft PROPERTYLINE <br /> ❑ FILTER BED WIDTH ft LENGTH R UPON ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCETONEARFAT WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DiSfANCETONEAREST WELL A FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NumBER WIDTH It DEPTH ft <br /> DISTANCETONEAREIST WELL R FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK W ILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM27, UR ADVANCE NOTICE REQUIRED FOR INSPECT IONS-PLEASE CA LI.(209)953.7697 d <br /> SIGNED "�`7�-/[ -_r TITLE <br /> F Q <br /> +. I PA <br /> ❑ ,III '"� s�h239 5,0 � RFC <br /> o c9 A'e j '�� DEC <br /> b 'a <br /> SAN JOI E T <br /> / N ENVI <br /> o X d ! -'_' A37.1T 450.Bh• HE ". EAR M1 10 <br /> InAn. <br /> i <br /> 9,0 oi9r9p'!' <br /> A A SO <br /> 0R <br /> 23 <br /> SOJ do 5157 <br /> 5 1�1 <br /> omeotea oad <br /> DEPARTMENT USE N „$- <br /> Application AccepteT(By - "'��- Dale 12 JS�pY Arra : Employee We q 9� <br /> Final lnepatian By. Dade ❑ SPECIAL PERMIT-Appmvedby <br /> Character 0f Soil to 1mpth of 3 FU PiuSump Sail Character: <br /> COMMENTS <br /> PE SC Recdved Cha Amount Date Pe.111 ' Invoice# Permit lDp <br /> Coda INFO i B Im Remitted Service Re DeaI# <br /> 42.x2 'i l 7 L 7C1 5�1.vuJ h j c <br /> e2lH-Rpl ONSITE WASTEWATER PERMIT <br /> i=W003 <br />