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ONSITE WAS ±WATER TREATMENT SYSL <br /> ' M PERMIT ` <br /> I, <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH�ARTMENT 304E WEBER A 31°FL-STOCKTON - 20 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7597 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS I n q�1�n' r�( LA <br /> CITYIZIP (� C <br /> CROSS STREET t�n �!�`�-� APN ,LCi Z 3 PARCEL SIZE ' p <br /> b <br /> OWNER?NAME l .e} • , 1I.1�► �/y� /� /1 (�/�PH/OyINE SOL) --10(x) (�/� v� <br /> OWNER ADDRESS tiSb� f fhlMl 1 ��� t \N�- 7�' '-7 C� CITY/STATE/ZIP P!p`-ie,�� CA 1.]ci-7o <br /> CONTRACTOR _ _ -- - - - --_ _ PHONE 5 r <br /> t <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER ExpjgkkioME <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates'' X Y <br /> PERC TEST # .. BUILDING PERMIT# - LAND USE APPLICATION# FA- 84-13DCNS) <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑- 'REPA[R/ADDITION ❑' ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION . <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER___ <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gat #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ LIFT STATION SIZE y TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM. <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY,LINE. ft <br /> ❑ FILTER BED WIDTH ft LENGTH.-I-_:'_ - R DEPTH ft 6 <br /> DISTANCE TO NEAREST WELL ft..,,FOUNDATION ft PROPERTY LINE + ft 1 <br /> 1 <br /> 17 MOUNDED WIDTH ft LENGTH ft DEPTH R W <br /> Ei DISTANCE TO NEAREST WELL 1i FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft ') <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R: DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> M1 S <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLIC {B.IQN AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OP SAN JOAQUIN COUNTY:. . . <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL,(209}953-7697 <br /> SIGNED; TITLE_, DATE <br /> 41 VVII,-- <br /> //R[ <br /> ; 1 <br /> I' _ � <br /> ST PAN=a <br /> Eksackr wL 5" I= A u 1 ' <br /> 10% � <br /> as aG 16s. %AM Ill R; <br /> P. <br /> gar tires.ow -I " 10.011,1rnEs oat <br /> mm lar <br /> 1-17 O 11= :. O TS 14 - 16 II 11!11 T <br /> a► .I Leo+enc IMeM1A1= >z VAR=o <br /> 1 NSMMox <br /> 9,17 NEWS PU <br /> N _ Al T ��_7Jw@.til• _ _ _- ___ _ _ - _ _ I, S <br /> rx <br /> -•.a a ,y 1. <br /> 0 _ <br /> r <br /> - - - �- - AEYARTME1VT --� -- <br /> Application Accepted By Date f l7 'Q� w Area x_ Employee[D# p� "M/ <br /> Final Inspection By Date ❑, SPECIAL PERMIT-Approved by ` 9 <br /> Character of it epth of 3 Ft: Pit/Sump Soil Character: <br /> COMMBW� 4 t3 �l <br /> S b CSI . 5c,e -� <br /> E SC Received Ilec Amount Permit! <br /> Code INFO B Cash Remitted .Date Service Request# Invoice# Permit ID# <br /> 5 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br /> y <br />