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ONSITE WAS'-,,WATER TREATMENT SYST' ''I PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER Ate!3"'FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPEC IONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS �S� + 97 ^ l CITY/ZIP CROSS STREET m �,,I�t y� Gn��'/WOf� P APN /CJS��O -'�al PARCEL SIZE 3, ,3� OWNER NAME ��/7N%! ►J (. --tIw 0/yNN2ose'� l r� L / PHONE OWNER ADDRESS �y$1 W�'I1/�. f-�,� s(, Wptf CITY/STATE/ZIP Z—'7 ' C Lle CONTRACTOR hl(1DO AI Q s&a-r (PHONE Z��/ CONTRACTOR ADDRESS CITY/STATE/ZIP LI LICENSE C-42 Ll -7, 7 C-36 OTHER NUMBER Q EXPIRATION DATE - WATER TABLE DEPTH: 1-t GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# © OU TYPE OF WORK: Ze, NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: El RESIDENCE COMMERCIAL ❑ OTHER /// NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: �PTIC TANK TYPE/MF `rt/lCIV�f J4,1,�y�/ SC+ /�C CAPACITY gal #OF COMPARTMENTS Z ,u,/ CREASE TRAP TYPE/MF �C ��/�`'� /y10�✓��`lnh� CAPACITY 2-OVV gal #OF COMPARTMENTS Z' ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES ❑ LEACHING CHAMBERS ��TY�9�2 #OF LINES 73 LENGTH OF LINES Z _ ft DISTANCE TO NEAREST WELL 2Gv ft FOUNDATION 0 ft PROPERTY LINE .5o ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft 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 ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH_ ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ,(/SEEPAGE PITS WIDTH :9-- ft LENGTH It DEPTH 2S ft DISTANCE TO NEAREST WELL _ ft FOUNDATION ft PROPERTY LINE Z-7, ft I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, TE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINI HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE O/A/"-k f�� - DATE i 1 � 8 r 0 P P - ' p N y, DEPARTMENT USE ONLY Application cep y �cs--- Date 2 n Area l ( Employee ID# Final Inspe tion By Dat ❑ SPECIAL -Appro ed by «<v Character of o Dept of 3 Ft: Pit/Sump Soil Character: ��7 ofrr.T COMMENTS - Ir 2-3D4, 33- PE ;3 3 /`(u ne.0 . ei'e �' Q-. rCY� L-4 " e-��C` lr+•.rs . c- PE SC Received Check# Amou Date Permit/ Invoice# PennitlD# (Code�' INFO By Cash Remitted / Service Re truest# 2,i 42-01-0 � � IT 12/2.02 /��