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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3"Fl,-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT LC�ALLL 209)953-7697 FOR INSPECTIONS EXPIRES l YEAR FROM DATE ISSUED <br /> JOBADDRESS f� �a- T`�Q{g. DR CITY/ZIP STOULTOfN) Q5ws y <br /> AN/ -CA PARCEL SIZECROSS STREET �2 <br /> OWNER NAMEGR,V� � <br /> n <br /> T <br /> PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR 5H%QT 56PZ1G 17f'I tLY rq jkj C, 'll)G1.-3�1_7S57 <br /> PHONE. <br /> CONTRACTORADDRESS i 5, Q 'Lt.D _ 2K CITY/STATE/ZIP LO 1 Q 2.V0 <br /> LICENSE 2 C42 ❑C-36 OTHER NUMBER EXPIRATION DATE 07- <br /> WATER <br /> ZWATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X y <br /> ❑ PERCTEST # BUILDING PERMIT# O503bS3 LAND USE APPLICATION# <br /> TYPE OF WORK: 9L NEW INSTALLATION ❑ RF.PAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: num NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: Li <br /> �7 Za <br /> 13 SEPTIC TANK TYPE/MFG IVf�aAloT CAPACITY 2,000 gal #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPFJMFG CAPACITY gal #OF COMPARTMENTS <br /> �1�N 1 001 fi <br /> ❑ PKC TX PLANT DISTANCE 70NUAREST: WEI.I. R FOUNDATION -LV fl PROPERTY LINE tom, <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) V <br /> 13RLEACH LINES ISL LEACHING CHAMBERS #OF LINES 3 LENGTH OF LINES <br /> ..CC �-F51 <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE S r fl <br /> !-n C1 FILTER BED WIDTH R LENGTH R DEPTH ft <br /> 1 <br /> SII DISTANCETONEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> P ❑ MOUNDED WIDTH ft LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft LENGTH R DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> I/3 f3L SEEPAGE PITS NUMBER 3 WIDTH 3(&" ft t ft DEPTH 7 f R <br /> DISTANCE TO NEARESF WELL r ft FOUNDATION 12.o' R PROPERTY LINE 5-f R <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> Q ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> N MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE.CALL(209)451-7697 <br /> SIGNED ti. �1MM'T TITLE DATE <br /> 2W <br /> fli <br /> M 17 <br /> N� tY <br /> tse, <br /> gY y43 7C: 200 <br /> Y <br /> 7V <br /> s\ �. <br /> nIFT:tLD REVI% <br /> I ING U <br /> ENV LPAEff AE 4T <br /> ►ARTMENT O Y <br /> A lication Acce ted Date '� <br /> PP P Area Employee ID# _ 9 <br /> Final lmpectlon 'e Date �-/—/?/LL- ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth f 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS f� 5 7c✓J� T9�t J A9Y S/7c% i'Yj�/�i�il�T std' <br /> aG_f3eZi7ilrc,Iffc:Kc/eeG.st>Z7�u'�i ��ic/AIn')•/1 L% /7=.LF�r��c <br /> PE SC Received Check}!/ Amount Date Permit/ Invoice# Permit IDN <br /> Code INF- B Remitted Servke R uest# I <br /> . )J mss•-.-. -7 / /.�.... �-,�._ - > _.-,. „ .. __ ._ <br />