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y ONSITE WA T WATER TREATMENT SY M PERMIT -- SAN-JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 344 E WEBER.-,-z-3"°FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT y CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 2'Z �" A-) CITY/ZIP H tf CROSS STREET Std A APN — PAQRCEL SIZE /-Z QCr tv OWNER NAME i A C C EJ d ✓Ld TI .L-1�lt" PHONE 0 35— (,)q-()G OWNER ADDRESS L 1o�C `S �G�" `� --- -- CITY/STATEIZIP CONTRACTOR PHONE CONTRACTOR ADDRESS CITYISTATEIZIP LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE . WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION! Coordinates' ,X Y ❑ PERC TEST # BUILDING PERMIT# J9P-- OSO!n� L LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF L1v1NG UNITS: NUMBER OF BEDROOMS: J NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG CAPACITY 1 Q gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY, gal #OFCOMPARTMENTS ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL So+ ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED/SYSTEM) �1 LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH-[ OF LINES [ co R � DISTANCE TO NEAREST WELL ft UNDATION �� R ' PROPERTY LINE ft N ❑ FILTER BED WIDTH ,!Pft LEN ft DEPTH ft N DIST CE TO NEAR�r.'. WELL A00011 OUNDATION ft PROPERTY LINE ❑ MOUNDED WI THA .. fit LENGTH ft DEPTH ft }v D�S #q All IANCE TO NEAREST ELL ft FOUNDATION f3 PROPERTY LME' ft ❑ SUMPSTH ft LENGTH ft DEPTHro ft DISTA TO NEAREST WELL ft FOUNDATION ft PROPERTY LME ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft } DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE `a ft �` © SEEPAGE PITS NUMBER I WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 1 HEREBY CERTIFY THAT I 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, INIMUM 4JMAAkADVANCE NOTICE REQUIRED FOR INSPECTIONS PLEASE CALL(209)953-7697 SIGNED TITLE V W^'IE-AL DATE r Z[ -- / /l, FINCK - — —E— N80 02'00 W ss1-88'TE— — �E— -- - _> F—� ------------ 15' O PROPOS 9 400 5'f' ��.i'. Lfl GWIA Clk PP. ~r°i � � `: 11 In I DING I bo CIO .} 20' 1 PROpp50 a � 156' I NE► - F3lcE paL� 4ti: s� �t�f PNENoPt�a ED PROPOSED LEAO" FIELD M p'OPAAF-�A�K L EXrSTING TOE OF SLOPE - TANK W N77'58'00'w � . oo.tl N78 28'00"W 394.64' -- c. 42-4 -- _- .-.. DEPARTMENT USE ONLN Application Accepted By Date 1 QS Area Employee ID# Final Inspection By Date © SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS O L-0 t~oT o F 10-6 C-0 2� 4-E,4-CH' r-I E-c.-d A_g c s7'/&& A,'r c_F_4&-T- I no j=r7 F-`Q° 4-0 s-F p7-7c +_s: e3-r- 4-!r LX--As7--50 F_T- EgAt oL-6 /—';.vim• M L T C-_ -e7- Q PE SC Received heck#/ Amount Permit/ Code INFO B ---cash- Remitted Date Service Re uest'# Invoice# Permit ID# 42,t( 11-7 4151© 42-02-001I {p �T �C'/ill� it S E -PERMIT 11122f2003 ;.