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ONSITE W, IS.VATER TREATMENT SYS-171 PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEAL;I It DEPARTMEN'r 304 E WvBE 1;_-3� FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL CALL2119 T 953-7697 FOR INSPECIONS � EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS ' C I ;� '� L A CITY/LIP 114 �p C� � 2 ,i � � � 70-0 y CROSS STREET A APN � �{3 �j / `-/�� PARCEL SI!.E J > 0 OWNER NAME LAA f �L 1.!' (3 I' i i /fu rl, PHONE •1 L'� 5 E ° y OWNER ADDRESS CT v�2 ' / CITY/STATE/ZIP CONTRACTOR 4p- In � (�/ IV r7 �� I� -x' /•V PHONE,,11-'•-12 SL-t-7 CONTRACTOR ADDRESS CITY/STATE/ZIP rill Ir n it FBI r 1.1yr if LICENSE U C-42 U C-36 (OTHER NUMBER Ex 1 DA WAFER TABLE DF:VI11: _ Il GF.O(:ItAPlll('A1.INI;ORMA'I'ION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: R1 NEW INSTALLATION ❑ REPAIR/ADDITION Lam--"ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER NUMBER OI'LIVING UNITS: 1NUMBER OF BEDROOMS: / NUMBER OF EMPLOYEES: LJ SEPTIC TANK TYPE/MFG 2 � Y/t, �, 5 C�� CAPACITY gal #OFCOMPARTMENTS `- ❑ CREASE TRAP TYi,r/MFO_ CAPACITY gal #OF COMPARTMENTS / ❑ PKG TX PLANT DISTANCE To NEAREST: WELL �i �� (� ft FOUNDATION ft PROPERTY LINE ft r �.l ltd-C"10 0 LIFT STATION SIZF: TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) J ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE.T(I NEAREST WI'.I.I" ft FOUNDATION ft PROPERTY LINE ft tr 1 FILTER BED NVIDTH c> 11 LENGTH JU l ft DEPTH_ b "/� ft DISIANCE'rONEAREST WELL 10,1 fl FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH -ft DISTANCE"I'O NEAREST WELL FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTiI ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL _ fl FOUNDATION 11 PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION 11 PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDm ft DEPTH ft DIST'ANC'E TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft 1 HEREBY CERTIFY THAT 1 HAVE:PREPARF,D 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. NIININtunt 24 HOAR At)%ANC'E:NOTICE REQUIRED I-OR INSPECTIONS-PLEASE.C:V.1.(209)01-76°17 SIGNED G ,��—'� 'fl"I'LE��-.t�-:/-. -�� DATE 90' PROPOSED F/L TER BED (SEE OETA/Z S SHEET 9) —' — — P. V C. ZEA01ZINE I ( I I 4' ON CENTER TYP. 15• II;IIIIIIIIII I Ilfl I o / • I I I I I H �I TAI i l l l l l l l l l � IIIIIII 'e � PI,IHIHHIII Ilil � � l / H4 M HI jol 9 III� oIIICI � I A �5 n°� 7$1 d LHII _a, 9 ; H. rL 50• a V a0 0 ITi,PAR I MF,N'FO ll ( NLY Application Accepted By Date Area ^� I.�_ Employee ID# 1 Final Inspection By ..__. Date ❑ SPECIAL PERMIT-Approved by j Character of Soil to Depth FL• it/Sump Soil Character: COMMENTS ' , _ / _ - 0 PE SC Received Check#1 Amount Date Permit/ Invoice# Permit ID# Code INFO it Cast I2emilled Servicc Request# ONSITEY, WATER PERMIT 42-02 OOI 12122 2003 5' C'C'