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,J L1 ONSITE WASTEWATER TREATMENT SYSTFNJ PERMIT // 610 ltm <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH D TMENT 304 E WEBER A 3""FL-STOCKTON CA 95102 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT 'tALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> � <br /> JOB ADDRESS 13161 �• /1l,0,- TD Y1J2r, CITY/ZIP ��7���� q Q� <br /> CROSS STREET '�} 46-60 l&/Vt/4i(] �-p�l APN ���- ��-o-R/�n/I.�! 1 Z I,54ARCEL SIZE � 1•D � � ti <br /> OWNER NAME PHONE__2-v'I <br /> w <br /> OWNER ADDRESS 'SnuffiCITY/STATE/ZIP f�aylla N616, CA 9=R <br /> CONTRACTORAMcrwil T PHONE—r• <br /> 7-4,701 U� <br /> II yy rr�� <br /> CONTRAfTOR ADDRESS _�__T�nC�U fa l Ujcr n CITY/STATE/ZIP CA <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: / A GEOGRAPHICAL INFORMATION: Coordinates X Y 11 I1 <br /> PERC TEST(S) NUMBER (0 LAND USE APPLICATION# v <br /> TYPE OF WORK: is NEW INSTALLATION ❑ REPAIR/ADDITION Q ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DEST <br /> L upL. <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE El COMMERCIAL ❑ tIj) E'R <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: �L7Af R OF EM OYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL, ft FOUNDATION ]t PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) �. <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ti <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL 1t FOUNDATION ft PROPERTY LINE. ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH ft DEPTH - ft <br /> DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE ►j.`i ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED T141S APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINAR}CES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSP TIONS-PLEASE.CALL.(209)953-7697 r <br /> SIGNEDol TITLE V ( DATA <br /> T' Gra-dl <br /> 2 KA <br /> a <br /> Parte€6 <br /> 0 1 <br /> N JO,kOL.1 <br /> M rL <br /> DEPARTMEN USE ONLY p <br /> Application Accepted By �` Date �z�� U Area 1.mp}oyee IDH Cly Z 0 <br /> Ci'nai in3pec Ivn Ty Dale �/ u Sil:Ci hE.r'�L'itY`.:,=. FN,�,cu y YC9 <br /> Character of Soil to pth of� Pit/Sump Soil Character: <br /> COMMENTS �' /SO <br /> or <br /> PE SC Received Check# Amount Permit/ <br /> Code INFO B ash Remitted ate Service Request# invoice# Permit IDN <br /> 14 2 z 2-S <br /> y.So iv <br /> 42.01-001 <br /> 1212102 ONSITE WASTEWATER PERMIT <br />