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ONSITE WAST WATER TREATMENT SYST- 'F PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH I�WeRTMENT 304 E WEBER A&-A"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 5. MPtIJTt1E ( 120 CTTY/Lm L-A<rlA-alkP q!5330 <br /> a <br /> 1 <br /> CROS.SSTREI'T t`--i�LJ APN 'A�' ); > <br /> Y <br /> L' 1 . '1.51' Ir � <br /> OWNER NAME SLwE;e_ CAA'ksE -DEJt4 0P4at.(Gj L'.O PHONE <br /> OWNER ADDRESS .A� Ju 1� 'A'�-r CITY/STATE/"LIP I t/ CI 1 <br /> CONTRACTOR �_t-bDOrYW 5&r Mwc. l '/�' r PHONE `- UD-VS6$ <br /> CONTRACTOR ADDRESS IS51 �. ��%0Ae4 AAJE-, CITY/STATE/ZIP tTbIll;�iC-Pji CA `51205 <br /> LICENSE 0042 ❑C-36 OTHER NUMBER 1.-r SQS-`S EXPIRATIONDATE ZU O-S <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y U, <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: V NEW INSTALLATION ❑ REPAiR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE �y�pMq(g� yp�I ��VO{I�y'MERCIAL TBE /2 <br /> NUMBER OF LIVING UNITS: �r�� '-�Z�p. � NU}MByER OF BEDROOMS: NUAIBE�O •MPLOI'EES:r �J ^ <br /> ® SEPTIC TANK TYPE/MFG LJ�N( R-E-I e - r$L CAPACITY I Plot)0 gal - #OFCOMPARTMENTS Z. 1 <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION t+ R PROPERTY LINE Jy' R <br /> ❑ LIFT STATION SIZE TYPE OF Pu - ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) 1 <br /> N <br /> ❑ LEACH LINES ® LEACHING CHAMBERS 3S - EQ 3 #OF LINES LENGTH OF LINES ti <br /> DISTANCE TO NEAREST WELL-------ft----FOUNDATION R PROPERTY LINE tl <br /> 10 FILTER BED WIDTH 201 it LENGTH L-(p1 ft DEPTH ft _ <br /> DISTANCE TD NEAREST WELL 100'+ R FOUNDATION (0i4 R PROPERTY LINE Lot .� <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH it <br /> DISTANCE TO NEAREST WELL [t FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH it \/ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH tt LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE it <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE.NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED r TITLE -L DATE Ofo'D2,103 <br /> UI G ON <br /> U8L C H AL H p St <br /> 1 <br /> S M <br /> 'D <br /> I <br /> 5414 <br /> as� N <br /> / ©U C, S 7 = 2 <br /> ch <br /> ' c <br /> ' s I <br /> " 3 <br /> i14 1 1 1G t <br /> _ DEPARTM T USE ONLY � �/ <br /> Application Accepted By Date = •'� Area —+�--�+` Employee ID# �) <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of FI: Pit/Sump Soil Character: <br /> COMMENTS �iP!"/ — T� <br /> / ZLaJ CG .S. ., - '441L<Zes4u/6' = 1rZe1 <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit IDN <br /> Code I INFO By Remitted Service Request# <br /> ro co3g03] <br /> 1 6Z 5721 -7eA 1-331 aq . 3 s .man <br /> a2-01-001 ^''+ 1— <br /> I2W2 i a 83� 5 / #iA y ONSITE WASTEWATER PERMIT <br /> rw <br />