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laar� <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTHDEPARTMENT 1868 East Hazelton Avenue-STOCKTON CA 95205.6232-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JoDADDREss 24 N- I wl 99 CITYmP A(ihMFV 9'S22a <br /> yroob3v I fRDN7ka E APN 007^tb6 1 N <br /> CROS9 STREET PARCEL SIDE Z,S°� c <br /> OWNER NAME SI/��hT'I rl 6Ac�ij,lt - ^'PHHIO�N�A-04)�3za- 2(33(0 9i <br /> OWNERADDRES(S�(�✓-L(7y2�I3' N" 4wq A9 w CITY/STATEMP f^�hmeo1T (CA qsW' <br /> CONTRACTOR VF VUIe �I, T(6QY1'. /LN(l -DAVID DUKE PHONE �710n A���(, pa`� J, `! <br /> CONTRACTOR ADDRESS 9R L• YL(/ top= RD /y��f��µIQA C"ISTATEZP Kfl,,MI/0 CA V"Z26 <br /> LICENSE QCA2 QC-36 OTHER -(O (-1'0 NUMBER_5 1 V l EW+IRATIONDATE %bb W <br /> WATERTAGLEDEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERCTEST :f BUILDING PERMIT$ LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION D REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLALEMUNT DESTRUCTION O <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LWING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITYgal #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL it FOUNDATION R PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES R <br /> DISTANCETONEPREST WELL R FOUNDATION-ft PROPERTYUNE it <br /> ❑ FILTER BED WIDTH it LENGTH R DEPTH it <br /> DISTANCE TO NEAREST WELLit FOUNDATION it PROPERTY LINE R <br /> ❑ MOUNDED WIDTH it LENGTH_ R DEPTH R <br /> DISTANCETO NEAREST WELLR FOUNDATION it PROPERTY LINE R <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH R <br /> DISTANCETONEAREST WELL R FOUNDATION R PROPERTY LINE it <br /> ❑ DISPOSALPONDS WIDTH R LENGTH it DEPTH R <br /> DISTANCETO NEAREST WELL R FOUNDATION it PROFERTYLINE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH It <br /> DISTANCETONEAREST WELL R FOUNDATION it PROPERTY LINE R <br /> 1 HEREBY CERTIFYTHAT 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 /> MINA ,124 HOUR ADVANCE NOTICE REQUIRED FOR INSPpECTIOtyS-PLEASE CALLL209)953yT6.8LIV,. 1�II✓ <br /> SIGNED TITLE YIh-Gl h.gpfi/� ��]]��,,I'�+�Y DATE, <br /> D <br /> 3 <br /> i - <br /> 1 NTy <br /> I. A <br /> r <br /> LU <br /> •A <br /> DEPARTMENT SE.ON Y _�^� rpt-, <br /> Application A .p y Date "P Area Ai I 7� Employee I❑#T�SI�V <br /> Final Inspect ion Data /L ❑ SPECIAL PPERMIT-Approved by <br /> Charecter of Soil t epth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS Rgf/, ` T/G�1kfCS/ /�/qy �`"� ✓✓� �F/J—/ ''C/C/� W'�` <br /> PE SCMI <br /> ChBPIUN Amount Date PermiU Invoice# PerrnitlD# <br /> Cotla IxFo Remitted Service Re oast#t LwK / OS.a� 7 000 S 7 <br /> 4941 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />