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'\./ ONSITE WASTEWATER TREA'II ANT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT SME WEBER AVE-3"FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL 2")9517697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED JOB ADDRESS (1 1 1�O) V (� <J �iC)I 141L�YF i J CITY/ZIP CROSSSTREET ..rN7(Ln LA1(L'1 �J APN /� -10' - UII PARCELSIPE OWNER NAME IIIZl11A L-C 1 V1� N C ILS ( PHONE -7 OWNERADDRESS 2/ IL1V 1-1,1( +n Ij 4Vvt\ CITV/$TATFJZIP 1 �` CONTRACTOR P`I ( TN{u S/ S(` Ci PHONE COMRACEORAOORE88 - CITY/STATWZIP �. 1 LICENSE ❑C-42 ❑C-3fi OTHE0. NUMBER EEPIRA..ON DATE WATER TABLE DEPTH: fl GEO MPHICALIWORMATION: CODINN eter X Y PERC TEST # —� RUILDINGPERMITN LAND USE APPLICATION# TA ' GS- LI(c 3 TYPE OF WORK: ❑ NEWINSTALLATION ❑ REPAIWADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY SRI #OF COMPARTMENTS ❑ GREASE TRAP TVPFIMFG CAPACITY 981 #OFCOMPARTMENTS ❑ PKG TX PLANT DISTANCETONEAREST: WELL R FOUNDATION IT PROPERTY LINE R ❑ LIFT STATION SIZE TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLINES LENGTH OF LINES R DISTANCETONEAREST WELL 0 FOUNDATION R PROPERTY LINE R ❑ FILTER BED WIDTH R LENGTH R DEPTH R DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE fl ❑ MOUNDED WIDTH R LENGTH R DEPTH R DISTANCE TO NEAREST WELT, R FOUNDATION R PROPERTYIINE _ R ❑ SUMPS WIDTH R LENGTH _ft DEPTH fl DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTYLINE ft ❑ DISPOSALPONDS WIDTH- ft LENGTH R DEPTH R ` DISTANCETO NEAREST WELL ft FOUNDATION R PROPER IY U\E fl ❑ SEEPAGE PITS N(IMBEp WIDm _ _ _ R DLPm fl DISTANCE TO NEAREST U'EII. II 1011NDAl ClIR. PROPERIYLINE R 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQU IN COUNTV ORDINANCES,51'ATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MISIM/U""M34 HOUR ADVANCI.NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED Y�/�. TITLE f 'M S-14AIAL`.- - DATE dI I jR F1 El6h ; u' h amb 429 � '^ ..gym. yy E ®! P P.D lama a g n&1§v6 I lea z-100 I I yq PARTMENT USE NLY Application Accepted By. I//.L� =� Z Data / +a Area Empioyw IM a Final lnapaelloD By Data ❑ SPECIAL PERMIT-AMmvW by Character of Soil to Depth of J Ft: PIVSomp Soil Character: COMMENTS PE SC Received Chadd# Aln I Date Permitl Invafce# Perodt IDA Cade INPO B u R4RIIHed ServkeR veal# a1c !.G I 11Ltt-7[ag5 Z. 42-(2-001 ONSITE WASTEWATER PERMIT 12(1212001