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ONSI:,,,_,-'WASTEWATER TREATMENT SYSTE— PERMIT <br /> SANJOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3-FL-STOCKTON CA 95202-(209)464-3420 <br /> NON-REFUNDABLE PERMIT CA 1,1, 209 953-7697 FOR INNPECfIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JoeADDRFss ^II Fl / F_ /�aucA 1 CmrlLW <br /> Cnass Mwr / APN rN S!-�ka--3� T PARCEL SIZE l y �gc <br /> OWNER NAME A l PHONE p <br /> OWNER ADDRESS GL.16NE T CnWSTATEMP <br /> CONTRACTOR PHONE !rO7-70 <br /> CONTRACTOR ADDRESS CnV/STATFMP <br /> LICENSE -42 OC-36 OTHER NUMBER EXPIRATIONDATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Cowdilates X Y <br /> 13 FERC TEST NSUIT DING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEWINSrALL.ATRH+ REPAUUADDrTION O ENGINEER DESIGNED/ALTERNATIVE <br /> 0 REPLACEMENT ❑ DE5TRUCITOIN <br /> INSTALLATTONWILL SERVE: OL RESIDENCE ❑ COMMERCIAL D OTHER <br /> Nl1MSEROFLIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOVEES: <br /> ❑ SEPTIC TANK TYPEIMPG Sys..C.�y CAPACITY /J gal N OFCOMPARTMENTS <br /> ❑ CREASE TRAP TYPE/MFG CAPACITY gal N OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETONEARLSr: WEIL R FoLNDATiON ft PROPERTY LFNE ft <br /> O LIFT STATION SIZE TYPEOF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I& LEACH LINES (3 LEACHING CHAMBER& 1)OF LINES LENGTH OF LINES NO s R N <br /> DISTANCE TO YEAnM WELL I Z":)• ft FOUNDATION 4T' R PROPERTY LINE tbI f fl _1 <br /> ❑ FILTER RED Wimp fl LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WHLI, fl FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED wrmx ft LENGTH it DEPTH R <br /> DISTANCETO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS wIRrN ft LENGTH R DEPTH R <br /> DISTANCETONEAREST WELL R FWNDATION ft PROPERTY r.INF. it <br /> ❑ DISPOSAL PONDS wlmx ft LENRFH it DEPIH ft <br /> DISTANcr TONEAREST WELL, fl FOUNUATION R PROPERTY LINE ft <br /> 112- SEEPACE PITS NUMBER 14 w mH R DEPTH d95� ft <br /> DewANCETONEAREST WELL _ft FOUNDATION i-Tl R PROPERTY LINE�R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPr.FCATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> .. ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HIMR ADVANCE NOTICEREQUIRED FOR INSPECTIONS-PLEASE CALL(269)951-7697 <br /> ~ <br /> sIrNE Z2 11TLE DATE <br /> ZA <br /> b <br /> O <br /> n <br /> 04 <br /> P <br /> IAVZAP JCc <br /> aru <br /> L <br /> DEPARTMENT rSE O' f,L�jyf <br /> Application Accept6'r-3 <br /> Dale V Area Employ"IDN 1�( •�'�ly <br /> Fleal Inspection By �'- Date ica�/�� D SPECIAL_ZERMI Approved by <br /> ChRracler of Soil to Fl: pithsinno Soll Character:iSf ��1�� ! c'� <br /> COMMENTS - �� -'t . c <br /> r ' - <br />' �i i� —e las- %..� . � �y � uQ.'>''>•,Jl <br /> PE 5C Recelred Che f Anwat Permit! <br /> Dale Invoice 0 Permit IDA <br /> Code Iwo B Gad Rrndz Service Request N <br /> Ic 1?�O.OD 10 D 2Z <br /> C42=-02.ODII ONSITE WASTEWATER PERMIT <br /> 03 <br /> k <br />