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qr-,—.--57J _. to / J_ - /v ONSITE WASTE�kTER TREATMENT SYSTEP" PERMIT T' SAN JOAQUIN COUNENVIRONMENTAL HEALTH DEPA ENT 304 E WEBER AYH 1"4:1.-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 VEAR FROM DATE ISSUED JOB ADDRESS CITY/ZIP 'Trtaw. "16-377 CROSSSTREET kwkA cn�a APN 2 '�4U -�17 PARCEL SIZE '46. T (Y`l �7�� 0 OWNER NAME. MA�I',,1 Lc_e -T(-Q/C'/ ' \LLC `PHONE - OWNER ADDRESS (-JL'C-�f�Prb S�-LTr'S l Qh-<JII\`�Q4 CITY/STATE/ZIP CONTRACTOR . tEl�L1 CL cPHONF. y�-1/3 5 CONTRA(TORADDRESS ;2Z2_S G. MSV>1'TIL U1 - CITY/STATE/ZIP JCJL/VO� CA LICENSE ❑C-42 ❑C-36 OTHER NUMBERZ EXPIRATION DATE WATER TABLE DEPTH: H GEOGRAPHICAL INFORMATION: Coordinates X Y FERC TEST(S) NUMBER LAND USE APPLICATION N PA-04-137 TYPECFWORK: ❑ NEWINSTALLATION ❑ RF.PAIN/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER _ NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTICTANK TYPEIMFG CAPACITY gal N OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG CAPACITY gal N OF COMPARTMENTS ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL H FOUNDATION 11 PROPERTY LINE it !� ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS N OF LINES LENGTH OF LINES it c DISTANCE TO NEAREST WELL R FOUNDATION fl PROPERTY LINE ft ❑ FILTER BED WIDTH A LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL III FOUNDATION R PROPERTY LINE fl ❑ MOUNDED WIDTH ft LENGTH ft DEPTH A DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R ❑ SUMPS WIDTH R LENGTH R DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS Win" R LENGTH R DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft ❑ SEEPAGE PITS WIDTH ft LENGTH fl DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTY LINE ft I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. NIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 - V SIGNED TITLE S' aEn6 n@Cf DATE_ s0=1.rE 3710.13' n F q ' ✓ - g ` E a o y 1 „aa.m• NOIIM n � ] w I LS pp a 1 Wf 1 „ 1 D 1 _ sTa-M r..�✓ 1 1 , ,V I C _ _ _ LT N _ _ _ DEPARTMENT USE NLY � I(fN7- Applieallon Accepted By ../ Dale .S- )-ti �I C - Arca %-- Gmployce IDN �I- Find Inspection By -i`' c �^' Dafe 1 [ ❑ SPECIAL PERMIT-Approved by Chancier of Shc to De of 3 Ft: Pit/Sum Soil Character: COMMENTS lt�74 PEgINM Received ee Amount Dare Permit/ Invoice N Permit IDN Code B ash Remitted S�e7rv�icXXe Re oast N1 Z. c3 3 f o t7 lJ aO �G' uq O 6 Iuv .S 47-01-001 , /�'1 �� q �~ % /f*" - ONSITE WASTEWATER PERMIT INTO: /1'.'1