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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTM ENT 304E WEBER AVE-3' FL-STOCKTON CA 95202 -(209)460-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES/ l YEAR FROM DATE ISSUED <br /> JOSADDRESS I ZO-1Cl TU.�t.Y "•IZDr CITVIZIIP /� <br /> CROSSSTREET �DY-�A(`I,{CCJ Lo Ki APN Il to l/�t/ PPAAR�JCELSI'ZE1Ca^-'J� _ a <br /> OWNER NAME 'TT-r-k LwTZSCIIQ PHONE �J�-"t J�J,I A <br /> OWNER ADDRESS c•JTAMT9 CITY/STATFJZIP <br /> CGErr"cTOR _k.zvNAm-D .�'r�-sADY-t --XkjCi♦,��r� .0 PHONE 34:1-ZSS/'ZA.,���- <br /> CONTRACroRADDRESS 1 j$1 0. •iJft%?JRT RVG. C�rry/S�JT�AJTE/ZIP bT0c"yw � q zr l <br /> LICENSE 0C-42 0C-36 OTHER NUMBER -1S-t5cie EXPIRATIONDATE DZgO <br /> WATERTABLEDePTEr D CEGGRAPHICALINFORMATION: Caardinatcs X y <br /> ❑ PERCTEST(S) NUMBER LAND USE APPLICATION# —� <br /> TYPE OF WORK; Q NEW INSTALLATION REPAIWADDITION ❑ ENCINECRDLSIGNED/ALTERNAT'IVE <br /> It REPLACEMENT - GC DFSTRUCI ON <br /> INSTALLATION WILLSERVE: RESIDENCE ❑ COMMERCIAL . 1 ❑ OTHER <br /> NUMB ER OP LIYINC UNITS:_pp�0�''I NUMBER OF HEDROOMS: 4 NUMBER OF EMPLOYEES: fqU <br /> IJa SEPTIC TANK TYPMMFO Cm!. 4— ID AL CAPACaY Z10DO 9001 90FCOMPARTMEWS L O <br /> _ -- <br /> ❑ GREASE TRAP TYPF/MFG CAPACITY 8M #UFCOMPARTMENTS V <br /> I fv <br /> ❑ PKC TX PLANT DISI'ANCLTONLARESf: WELL—5G D 'F R L7 <br /> FOUNDATION 2 D PROPERTY LINO ZCJOJ 0 \J <br /> ❑ LIPTSTATION Sim TYPE OOFPUMP <br /> =0., � 1 13SAND 011.SEPARATOR(ENCL(HUMSYSrE:M) <br /> LJLEACH LINES IN LEACHING CHAMBERS IQT Lgk Z.Y OF LINES LENGTH Or LINES ( I H <br /> � p <br /> DISTANCE TO NEAREST WELL � f7 'F R FOUNDATION 'Tl1i R PROPERTY LINE •L-+-�� Q <br /> ❑ FILTER BED WIDTH H LENGTH _R DEPTH it <br /> DISTANCETONEAREST WELL-—ft FOUNDATION R PROPERTY LINE Il <br /> ❑ MOUNDED WIDTH IT LENGTH _H DEPTH {I <br /> DISTANCE TO NEAREST WED. _R FOUNDATION _R PROPERTY LINO R <br /> ❑ SUMPS WIDTH R LENGTH _H DEPTH R <br /> DISTANCETONEARES'T WELL _R FOUNDATION_ H PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH_ It DEPTH R <br /> DISTANCE TO NEAREST WEU._ft FOUNDATION_ft PROPERTY LINE R <br /> SEEPAGE PITS WIDTH *b 4421' * LENGTH,;_ J R DEPTH gW —R <br /> DINTANCETONEARLST WELL �4sq"� R FOUNDATION 100 R PROPERTY LINE. 2(X7A R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE W'IT'H SAN JOAQUIN COUNTY ORDINANCm <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MIN MUM L HOUR ADVANCE NOTICE REQUIRED R INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED_ �' _ MR <br /> _ -�-'F b•R-- DATE t)Z414i(a 3 <br /> CSE <br /> a 1 i <br /> I <br /> - DEPARTMENT ID3EE OO4NL/SIN <br /> Application Accepted BY DateL-Lt c' A..� Employee W#_ <br /> Phial Inspection y_ Gc- ?hlli�r:.a.,. Due t"a��'i_ ❑ SPECIAL PER IIT•App.-.d by <br /> Character of Sol tho 31l1: plusump Spill Character: <br /> COMMENTS <br /> i <br /> PE RC Received / C6ce Amountf Date Par IV Invoice# Permit lDB <br /> Cale INPo B Cash Remitted Service Re Dett# <br /> 3 9 03 I <br /> 003�-7 9 <br />