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_ rs <br /> ONSITE WAS"WATER TREATMENT SYSTi PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTHII,.�TIENT 304 E WEBER A>1 %f""FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT �CA`LL.(209)95.3`-7697 FOR INSPECTIONS EXPIRES <br /> ' 1 YEAR FROM DATE ISSUED <br /> JOII ADDU/tia _�q_7�-,�J-. -_ D�i�__�.�Llh)1��.. f�UL ----- --- tll,,7.11•_A.�(�►Y��3.L._ -i <br /> 1 � Y <br /> rM <br /> ('Roti~tilImp.l ��lYlLlrl 6`ICV/�r `` 1 _ APN OU-] -�5U'.�q PARCEL SIZE �� .$ []lrc5 °v <br /> -lsOsl` l rM <br /> p <br /> OWNER NAME &bO,n 1 e- PHONE y <br /> \ <br />- OWNER ADDRESS V j� J,3C CITY/STATE/ZIP fr A <br /> CONT'RACT'OR {�/� �1L PHONE� `— q?7/1�3J� <br /> CONTRACTOR ADDRESS� 2S [E- 1 1\�{ C J 1. CITY/STATE/ZIP i94n f 64 12A <br /> LICENSE U C-42 U C-36 0111E t �- 7 NUMBER EXPIRATION DATE <br /> WATERTABLEW,'vi'm Il GEOGItAPIH('AI.INI+ORIIIA'I'ION: Coordinates X Y <br /> 19 PERC TEST(S) NUMBER 3 LAND USE APPLICATION# pA-03-6V <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE. ❑ COMMERCIAL ❑ OTHER <br /> NHMIIr:It IIF IINITS: NUMBtaI IIT Ilt:I111111Mis: Numnt R 1111 Emm.I►Yr,r:S: <br /> ❑ SEPTIC TANK TYPE/MPG CAPACITY __. gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MEG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION fl PROPERTY LINE tl <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL U F ND ft PROPERTY LINE Il <br /> ❑ FILTER BED WIDTH Il LENGTH 1 DEPTH ft <br /> DISTANC'ETO NEAREST WI[I I. 11 POtINHAIION _ Il PROPERTY LINE Il <br /> ❑ MOUNDED WIDTH 11 LEN6I'11 _ H DEPTH tl <br /> DISTANCt.'TO NEAREST WI.I.I. _Il POUNDAL ION _ Il PROPER'T'Y LINTS 11 J <br /> ❑ SUMPS WIDTII fl LENGTH 11 DEPTH ft N <br /> DISTANCE TO NEAREST WELL fl FOUNDATION 11 PROPERTY LINE ft Cl <br /> ❑ DISPOSAL PONDS WIDTH 11 LENGTH 11 DEPTH it <br /> DISTANCE TO NEAREST WELL I1 FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS WIDTH Ii Li-N(;']'[I 11 DEPTH <br /> DISTANCE TO NEAREST WELL Il FOUNDATION 11 PROPERTY LINE 11 <br /> r <br /> 1 HEREBY CERTIFY THAT•I HAVE PREPARED THIS APPLICATION AND"I'HE WORK WILL DE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> IME,UM 24 HOUR ADVANCE NOTICE.REQUIRED FOR INSPF.CI'ION+S-PLEASE CALL(209)953-7697 to <br /> SIGNED TITLE. f;�a'O(i- DATE, <br /> TENTATIVE PARCEL MM <br /> -c r - uoaom i rMa•L n"Y�" <br /> I <br /> ,-•r, <br /> J <br /> --------- --- -- __ - - __- - - --- - - - - 1 <br /> �i A-o •d <br /> DEPARTMENT SE ONLY <br /> Application Accepted y Date 3 1� Area 2� Z Employee ID# <br /> Final Inspectio y tea- ,� Date ���t�i ❑ SPECIAL PERMIT-Approved by / <br /> Character or oil epth o Ft: Pit/Sump Soil Character: <br /> COMMENTS ^ <br /> PE Sc Received heck#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Rc ue.. # <br /> 42-01-001 <br /> 12/2/02 ONSITE WASTEWATER PERMIT <br />