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/l t <br /> ONSITE WAS' WATER TREATMENT SYST Z PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH Dc�PARTMENT 304 E WEBER A*I'PW-3""FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 Y � O DATE ISSUED <br /> n <br /> JOB ADDRESS I f t.o5( E A/,M LIA_�E CITY/ZIP P <br /> CROSS STREET t t Lth 1 1 t_1 APN�.Z- T_5 D 92_ 5 PARCEL SIZE <br /> v <br /> OWNER NAME M l._. �DMM r? D f n b.5 I�� n PHONE ao 4 �'l'7- 5Z <br /> Z <br /> OWNERADDRESS '• 6eJx % CITY/STATE/ZIP !`�I o LDE_-5 I7 A <br /> CONTRACTOR /U/o De s T-z9 y,/5A-Al b � A 2AVEL_ 4/c- PHONE .-7p q " 5 y 5' /]4,41 <br /> 4 A CONTRACTOR ADDRESS LG�� ! / i M I%E 77- 10' CITY/STATE/ZIP AD .J TSU `1 U <br /> LICENSE LIC-42 LI C:-36 OTHER L `/ NUMBER I EXPIRATION DATE Z <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# r` <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ //ENGINEER DESIGNED/,,//ALTERNATIVE <br /> C3 REPLACEMENT GI-DESTRUCTION aejjL,�)14- <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: I� <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 R 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 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE tt <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH R 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 ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH_ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft. <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION tt PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT 1 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE.CALL(209)953-7697 <br /> SIGNE �c J-eC` TITLE AAA,,,k DATE U CV-1 <br /> ti <br /> IV U-1 <br /> n <br /> P11 Jill <br /> t~' p N PHN <br /> A plr E VI 10 M <br /> L <br /> r <br /> PARTMENT SE 'LY <br /> Application Accepted By Date_ (/J Area — Employee 113# 23 N <br /> Final Inspection By Date �O ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to De h of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS G /Y'o� .� <br /> PE SC ReceivedCheck# Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> yaalp 7 z z72 g6 /7 0j" 'c.�,n:JY�fL <br /> 42-01-001 <br /> 12/21/02 ONSITE WASTEWATER PERMIT <br />