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ONSITE WAS1.,,,,RATER TREATMENT SYSTT I PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AvvmW3NO FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 VEAR�F/R�OM DATE ISSUED JOB ADDRESS 't 1 1� � � �\ CITY/ZIP �o 1 (AT�� CROSS STREET �,/�� / p ( APN �V �1 PARCEL SIZE -/+ 700 OWNER NAME /�--I' ►\1 p ��;� j (�/•`',��/4�J ,�/ /�/� PHONE g p y OWNER ADDRESS --2W Z /UK—I—E-1 Pikes Of?-. CITY/STATE/ZIP �(JVj, / 513 CONTRACTOR MD t ? � y — PHONE--3(0�3 �� 4ZLICCONTRACTOR ADDRESS ZZ �+f- / ✓JJ ( (/�v LN; CITY/STATE/ZIP (tel Cie# (1 S 2-42— LICENSE ENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE 1�1w� WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X �V' PERC TEST(S) NUMBER LAND USE APPLICATION# TYPE OF WORK: A NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGIVI�—�Dkle—G*i+TERNATHE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE It ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ti ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH tt DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE tt ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ti DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 1 HEREBY CERTIFY THAT 1 HAVE PREPARED HIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, ATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. UM 24 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE sol c > DATE RO E G 'NTA _Ro-- - KGFWAY �•_ O/ • / C- '/ ,' f `�"G�yC .t-, ON-RAMP HIGHWAY . 14, ti of 10 0 �� C �� % HIGHWAY 99 61" DEPARTMENT USE ONLY r� ` Application Accepted By (; Date `, O Area Z �— Employee KA U V� Final Inspection By Date / /Q3 ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: t/Sump Soil Character: COMMENTS PE SC Recei Check_#/ Amount Date "Permit/ Invoice# Permit ID# Code INFO B Remitted Service Request# +)-u 521 7 ! 7•t/o4� �38�� 42-01-001 ONSITE A 12/2/02 .l