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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3-FL-STOCKTON CA 95202 -(309)468-3420 <br /> NON-REFUNDABLE-PERMIT CALL 209 953-7697 rORjNSPEqrIONs EXPIRES I YEAR 5ROM DATE ISSUED <br /> JOBADDRESS57 ✓/ CirrZP' 3 <br /> ` CROSS STREET ,,/ /^C (/''�/ / APN mq-28 + <br /> m <br /> Amex 0'q <br /> 0—oz PARCELSLZE 3-[G <br /> OWNER NAME W l�1�� L�L - 79 <br /> PHONE � zrrz <br /> NE p <br /> OWNER ADDRESS f %f_n liC/v� ilk([ • CITYISTATEJZIP <br /> CONTMCTOR �G PHONE S <br /> CONTRACTOR ADDRESS CITYISTATEiZIP <br /> LICENSE 0 C4 0C-36 OTHER NUMBER EKMMTION DATE <br /> WATER TABLE DEPTH: fl GEOGRAPHICALINFORMATION: Coerdliftj. X V <br /> ❑ 'PERC TEST N BUILDINGPERMIT# LAND USE APPLICATION# -' <br /> TYPE OF WORK: ❑ NEWINSTALLATION U REPAEVADDUDON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑' REPLACEMENT ESIAULTION ' <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE CICOMMER IAL CIOTHER <br /> NUMBEROP LIVING UNITS: NUMBER OF BEDROOMS: NUMEEROFEMPLOYCES: <br /> ,Z�$EPTIC TANK. -TYPEIMFG CAPACITY gel N OF COMPARTMENTS <br /> ❑ GREASE TRAP . .TYPF/MFO CAPACITY gel ,_NOF COMPARTMENTS - <br /> C3 PKG TX PLANE DIATANCE TO NIU RFST•, WELL "It FOUNDATION A PROPERTY LINE iO it <br /> ❑ LIFTSTATIONr SIZE TVPEOFPUMP '❑, SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑. LEACH LINES ❑I LEACHING CHAMBERS I R OF LINES LENGTN OF LINES <br /> DISTANCETONEARRTT ,. WELL ft -FOUNDATION . ft PROPERTYLINE it Vv <br /> ❑ FILTER BED WIDTH R LENGTH It DEPTH R <br /> DISTANCETONEAREST WELL fl"FOUNDATION - R PROPERTY LINE It <br /> ❑ MOUNDED WIDTH fl LENGTH ft DEPTH R <br /> DISTANCETONEAIM WELL _ fl FOUNDATION R PROPERTY LME _R <br /> ❑ SUMPS WIDTH R LENGTH-"' fl DEFIN R RI <br /> DISTANCE To NEAREST WELL R FOUNDATION ft PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WIDTH 'ft - LENGTH fl DEFTH fl <br /> DISTANCETONEAREST WELL-• R FOUNDATION, R PROPERTY LME fl s <br /> L ❑ SEEPAGE PITS NUMBER WIDTH ft DamR <br /> DISTANCETONEAREST WELL It FOUNDATION R PROPERTY LINE- It �^ <br /> w <br /> IHEREBY CE ATIN VE PREPARED APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAM JOAQUIN COUNTY , <br /> RDIN LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. ` <br /> UM 24 HO R E NOTICE REQUIRED FOR INBPE%%CCff''IOVH-P ECALy%%yJ��J2209X953-7697 �T <br /> SIGNED TITLE C_A���/BC/Q/lt�DATE V <br /> it, Ir <br /> 11 v <br /> 1� <br /> 4\' <br /> 3 0 <br /> 'J <br /> 111 P E fr <br /> IJ <br /> r aQD -rr <br /> i <br /> DEPARTMENT U E O LV <br /> Appiintion Accepted _ DBte -3 .O A..__ Employ.U)# / <br /> Fine[lmpttHon By ..Det< .❑ SPECIAL PERMIT-Approved by <br /> Chenrter of Soil to Dep of3Pt: PI/Sump So it Chancier: <br /> COMMENTS AZOo-1 o.J or— <br /> PE <br /> fPE SC Recelved 'Cllee Amount UBt<- . PermiU IevolTeR Permit IDS <br /> Code Info By u ReMHed S." DeMN <br /> 4224 oris 1 JD-7 /Do- o-Q 171,310 <br />