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Ta. / '�o ONSITE WAS VATER TREATMENT SYST�PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEP TMENT 304E WEBER AVE -30FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT , CALL(209 9553-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED JDBADDRES.S 5 // �0u/ 4 ri • CITY/ZIP 155C/44,9AI 9-S320 y m iif G a CROSSSTREET - WA<1 APN ZoS-o70-7S,llI PARCEL SIZE A� O 1, O OWNER NAME rnR • /W ON7 y ANpE2 aee,< PHONE S 38- ;e /6¢ ` ; C _ I OWNERADDRESS �S`rIZ E/457- 4V"/f E" CITY/STATE/ZIP LSCA 4=0/V CONTRACTOR GNE n/E COn/1/,cLr�/ PHONE OX'V-/¢03 CONTRACTOR ADDRESS • 0 O CITY/STATE/ZIP L(,2LOGAG LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEVI'It: A GEOGRAPHICAL INFORMATION: Coordinates X Y CA PERC TEST N BUILDING PERMIT# LAND USE APPLICATION# TYPE OP WORK: ❑ NEW INSTALLATION ❑ REPAIWADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: O(, ❑ SEPTICTANK TYPE/MFG CAPACITY gal It OF COMPARTMENTS 1' ❑ GREASE TRAP TYPE/MFG CAPACITY gal It OF COMPARTMENTS ❑ PKG TX PLANT DISTANCETO NEAREST: WELL ft FOUNDATION Il PROPERTY LINE tl ❑ LIFT STATION SIZE TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES It DINT AN(F TO NEAREST W1 I.1 Il EOIINDAHON II PROPIR Y I INI': Il U FILTER RED Wun'e Il LRNcrU_ __- _ _. — _ - It IN PIll CHI ANIL to NEAREST WELT. Il FOUNDATION It PROPER IY LINE: � 0 ❑ MOUNDED WIDI it Il LENGTH Il DI'THE tl DISTANCE TO NEAREST WELL It FOUNDATION fl PROPERTY LINE tl ❑ SUMPS WIDI'11 Il LEND III Il DIt PI-D Il DLSrANCET'O NEAREST WELL It FOUNDATION it PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It 1 HEREBY CERTIF THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTl' O ANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINI ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE:CALL 1209)953-7697 SIGNED TITLE Ot✓ L DATE _ R. 8. - r V'A III �`i A9 O OIC '•' A9z ili a^o� t9 0'0^ nF rn 20' 25'C z 2 oOK I'I .y_F tr 'I 1981.0'0. 5130` PARCEL T1" LJI rfK s4 r \'mm K . . � PARCEL "2" at m r ax `2Zh -- PI c Tbi f'' fTlLIP IIa P il�• .y PARCEL "3" � PEcc Ar 1 -,nti srng r I I ,.I•,� mmi I I ' l I �-i I I I I I I -J- 1 I I I I ILL I -1 PARTMF,NT USE/)NL'/1? Application Accepted By- e_� ///IArea _ Employee ID# Final Inspection By 40II)`r'- i Y �, " ;, -L,�;� - Date % LI 1,.'111 ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft•. Pit/Sump Soil Character: COMMENTS / �C T' c ' :;;ct /�'��3 PE SC Received C Amount Date Permit/ Invoice# Permit IDN Code INFO B Cash Remitted Service Request# 37_ L . '1 42-02-001 ONSITE WASTEWATER PERMIT 12222003