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11 �o ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA OUO2-(209)488 -0 <br /> NON-REFUNDABLE PERMIT CALL(209)963.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jos AooREss /7011 E-A<T LONE TR EE RD. C"mp E5Ca 4oa Z 95310 <br /> CRIMSTREET muRPNX APN 020.7-a00-OS PAR,cau.sizE �6O•% <br /> OWNER NAME /JA G.2 TL FAA&/LV //r✓/ T-ED PAKTNERJN/P PHONE 83s-anB � <br /> OWNER ADDRESS /p O SOJC /OZ(/ GRT/STATE/LP W SA/GRh�/f-NT0 �I SL9/ <br /> CONTRACTOR C/-/EsNE� /'oNS K.c ri./� PHONE �l��%'",13 <br /> coNTRAC10FA0DREBs P.A • 0Ox 37Y4 C17YISTATE21P 'T ea 144- [f} t <br /> LICENSE ❑Cd2 ❑C-J6 OTHER ,�(( NUMBER IR <br /> EXPATION DATE <br /> WATEATABLEDEPTN: It Gu:,C A HICALINPORMATOW COCnKMtee % Y <br /> PERC TEST k BUILDING PERMIT# LAND USE APPLICATION T # <br /> TYPE OF WORK: ❑ NEWINSTALLATION ❑ REPauLA0011M)N ❑ EHGwEER pEBwNEn/ALTERNATNE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILLSERVE: ❑ RESIDENCE ❑ CONN.. ❑ OTHER <br /> - NUMBER OF LNING UNITE: NUMSEROPBEOROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACT' gal #OFCOMPARTMENTB <br /> ❑ GREASE TRAP TYPE/MFG CAPACRY gal #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft (� <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP O PKGTXPLANT O SANDOILSEPARATOR(ENCLOSEDSYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFUNES LENGTHOFLINES R <br /> DISTANCE TO NEAREST WELL ft FOUNDATIO ft PROPERTY LINE R <br /> ❑ FILTER BED W.. ft LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL R FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED W.H ft LENGTH ft DEPTH ft <br /> DSTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WmrH R LsHV ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERNLINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FWNOATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PRS NumER WIDTH ft DEPTH i ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft- PROPERLY LINE R <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 /> 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)M-7697 <br /> SIGNED TITLE OWNE.2 DATE <br /> '1 <br /> LS R <br /> E <br /> E <br /> LL <br /> PARTMENT U E O! Y <br /> AppliCation Accepts DMe y Area Employee IDk <br /> Final Inspection By Dais ❑ SPECIAL PERMIT-Approved by <br /> Character of SBH to De of FL PIUS p Sell Character. <br /> COMM N !o �- <br /> PE SC Received Che Amount Permft/ <br /> `I— <br /> Cods INFO B Cash Rem#tedB Sarvlu oast# Invoice# Permit lD# <br /> zzz s a I 4LI-u.- Ys9jmr <br /> 42-01 ONSITE WASTEWATER TITRANT SYSTEM PERMIT <br /> ia4ro7 <br />