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-b :va ONSITE WAS ;'WATER TREATMENT SYS'T `[ PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH /TM ENT 304 E WEBER A yr�$L-STOCKTON CA 95202 - (209)468$420 NON-REFUNDAB P MIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED JOB ADDRESS M CITY/ZIP /-cf4,4 . /93-;17 m n CROSS STREET y�C_(O APN 141 —.130-07� PARCEL SIZE 3IV 71 g ♦AA d�,t� ,L /1 '1 y OWNER NAME /V4{J I- co A1p V"T\Q.� /P'HONE '1/O$)t�6d -/�� OWNER ADDRESS I Z 3 D I'rl'�Q I A CITY/STATE/ZIP A/l i_IO�S1 6403 JJ L / CONTRACTOR PHONE T 0Z CONTRACTOR ADDRESS I I CITY/STATE/ZIP LICENSE ❑CA2 ❑C-36 OTHER 4 NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X V ❑ PERC TEST # BUILDING PERMIT# -O LAND USE APPLICATION# TYPE OF WORK: NEWINSTALLATION ❑ REPAIR/ADDITION A ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER �y NUMBER OF LIVING UNITS: //�� I NUMBER OF BEDROOMS: d••�s NUMBER OF EMPLOYEES: pa SEPTICTANK TYPE/MFG Y Ck ACj /+ CAPACITY X OGO gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS I 1 El PKC TX PLANT DISTANCE TO NEAREST: WELL , © n/' ft FOUNDATION ft PROPERTY LINE ft _ LIFT STATION SIZE ? P P TYPE OF PUMP SDe 5-fl Ote HCQ ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) N ❑ LEACH LINES ❑ LEACHING CHAMBERS ` #OF LINES LENGTH OF LINES ft 09 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R FILTER BED WIDTH 20'k qt/ ft LENGTH ol s:/ ft DEPTH i t ft h DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH It LENGTH R DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE. R 1 HEREBY CERTIFY THAT 1 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. t�MpIINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED_[ I/l2-1. // TITLE�u�iyrrr7�.ii� DATEL ii LAY I P Q VV IN V O M 0 T " DEPARTMENT U. -73-71Application Accepted By Date !d 2A Cly Area Employce ID# 19 Final Inspection By Date D [I SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: PI 14 ump Soil Character: COMMENTS Xfu-ST dE /Ns PEg— EA/C� �� 9 PL 4^� Dnp �TOF QEcoQJJ• ct I• o IoO+fi .. 6= feu iZ- 'Trv.�Ps a o C'r n f/ (r I nelea ll-a-1 PE SC Received C ecldf/ Amount Date Permit/ Invoice# Permit ID# Code INFO By Remitted Service Request 42-02-001 �@(,pLlys.GS- IJ r..nl V✓44Y- 30014- f �--74--1 P1'�CNSITE WASTEWATER PERMIT 1222/2003 4tav+cwr.I ta/..' Rpl,- b t1 4o � !'rt0�, //✓1L allC A Lrrl+ w.nd/ a Pyud 47 Qsr. GL,s.�w-� •l Yd�n.�jlM�