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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 301E WEBER AYE.-3'°FL-STOCKTON CA 95202-(209)168-3020 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS J <br /> c CITYIZIP46 <br /> m <br /> CROSS STREET ���'C 1I APN l0V OTO - �� PARCELSIEE I -10- 0 <br /> OWNER NAME SK_5 '-za .(/n E7ENRA� PHONE <-3,'W—0 <br /> -3,''W—O <br /> OIYNERADDRESS .y�� CITYISTAI'RIZIP <br /> COMMCTOR /Ci CiLfi21/Y/r rr//�1 A10. �" PHONE <br /> / Lsr <br /> CONTRACTORADDRESS�O�LZ�% � %(/% "L-/� CITY/STATEIZIP ��2/�al /+jT �J"/i/�/ <br /> Y <br /> LICENSE. �C-02 ❑C-36 OTHER NUMBER EXPIRATIONDATE <br /> WATER TABLE DEPI'III R GEOGRAPHICAL INFORMATION: Coordinate, X Y <br /> ❑ PERCTEST(S) NUMBER LAND USE APPLICATIONS <br /> TYPE OF WORK: NEWINSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION C� <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBEROELIVINGDNITS: � I NUMBER OF BEDROOMS: 9 -LNUMBER OF EMPLOYEES: <br /> ( <br /> ❑ SEPTICTANK TYPR/MGG 1 ✓ _ _ CAPACITY F � _eel #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY % / Be] *OFCOMPARTMENTE_ <br /> m <br /> ❑ PEG TX PLANT DISTANCETONEAREST: WELL It FOUNDATION ft PROPERTY LINE R <br /> ❑ LIFTSTATION ,Size TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS y. BOFLINES -5`- LENGTH OF LINES ft <br /> D16TANCETO NEARE,T WELL L-�D�TII FOUNDATION�R PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH R LENGTH R DEPTH <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE B <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH Fl C/ <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE fl (n <br /> ❑ SUMPS WIDTH A LENGTH R DEPTH ft Z <br /> DISTANCETONEARESr WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WRYrR R LENGTH B DEPTH A <br /> yyy( DISTANCETONEARM WELL R FOUNDATION R PROPERTY LINE fl <br /> SCI SEEPAGE PITS W.Un ft LENGTH fl DEPTH <br /> DISIANCETO NEAREST WELL _2M'TL R FOUNDATION­,,�'Lf ft PROPERTY LINE Fl <br /> 1 HEREBY CERTIFY THAII 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 /> UM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(309)953.7697 <br /> SIGNE i TITLE G /J DATE < - <br /> a <br /> s <br /> } <br /> N <br /> IL r2�IL2> <br /> I F. ISH E GE <br /> .17 <br /> uq <br /> I S <br /> E \9R n,TA t GPS. .11111 ISIS <br /> IL <br /> Final inspection 11 DE Date ME _ r <br /> ApplkatiDn AttWted B 1 pare t -3✓ ,3 Ara �1 <br /> o I-II Employee 594-4 <br /> — /(/T`-' ❑ SPECIAL PERMIT-Approved by - - --- <br /> ChenclerefSailloDe of3Ft: PIUSemp Soil Character: <br /> COMMENTS SA OI 63 S <br /> I uEJ• Sari. aVs2NfL - Oa$7C7 S i <br /> l PE SC Received -CheeYp/ Amounr Dak PermiU Involcep Permit ID# <br /> Cade InFO B yr Remitted Service Re eea10 <br /> 2Ib 2 7b 350 D SP,00332Q <br /> a4equ"a 7 07 y 15F' ztucttfl- t�fz Td�- 9a M �" 6'§I �3si'W" � / <br /> �'OA"R'$�Lal�'-'7/�I/S.I'c S4'�/!�S)�/ �L A [ A R IT, <br /> /da6>rlt2KAJl>"07j +r+.onTT4 G6'JL1rJ6l1D.�F-•,u>•L�B000 OUYA�L�^aJ �;`sG/J2J�Q�/�/i091/rJ <br />