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9� ONSITE WASTEWATER TREATMENT SYSTEM PERMIT y SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3Y1 FL-STOCKTON CA 95202 -(209)468-3420 NON-REFUNDABLE PERMIT CALL(2091[953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS � U (.t�' 19�r f e, Acd(( 61�1 -z ` h N CROSS STREET nn APN PARCEL SIZE S 4 O OWNER NAME /GUN //�lI(r��I/�' �IG/✓/I,/D PHONE. OWNERADDRESS c2 1 41�p� /!� i CITYISEATE/ZIP CONTRACTOR ,L`• ( c> PHONE 3•-+Y^�3�v— CONTRACTOR ADDRESS /U CITY/STATE/ZIP t LICENSE ❑C132 ❑C-36 OTHER NUMBER EXPIRATION DATE I WATER TABLE DEPTH: R GEOGKAPHK AI-INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# - LAND USE APPLICATION# ' TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE LI REPLACEMENT - DESTRUCTION INSTALLATION WILL SERVE:. ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER 1 NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ,01"SEPTIC TANK TYPFJMFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP f TYPE/MFG I CAPACITY - 'gal #OF COMPARTMENTS .1 ❑ PKC Ti PLANT DISTANCE TO NEAREST: WELL R FOUNDATION R PROPERTY LINE R ❑ LIFT STATION SIZE TYPE OF PUMP ❑ ,SAND OIL SEPARATOR(ENCLOSED SYSTEM) •� ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft ' DISTANCE TO NEAREST. WELL R FOUNDATION R PROPERTY LINE R O ❑ FILTER BED WIDTH ft LENGTH R DEPTH ft (� DISTANCE TO NEAREST WELL R FOUNDATION - ft PROPERTY LINE ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCF.TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft �T ❑ SUMPS WIDTH ft LENGTH R DEPTH ft DISTANCE.TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ❑ DISPOSAL PONDS WIDTH_ft LENGTH ft DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATION .. R PROPERTY LINE ❑ SEEPAGE PITS NUMBER WIDTH R , "DEPTH DISTANCE TO NEAREST WELL R FOUNDATION R 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. M NI, 2 t1011R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PI EASE CALL(209)953-7697 J Q' SIGNED TIT 1- DATE C-S-J�02 i I. I I ` INCO N E VI O- I 1 141 Ll LIU Q a - -= Application Accepted (S�/"'� Date .� �� 0 Area Employee ID# Final Inspection B _ _ Date_ �eQ�/�37 ❑ SPECIAL PERMIT-Approved by Character of Soll to pth of 3 t: Pit/Sump Soil Character: COMMENTS 26 i PE SC Received Check#/ Amount Permit/ Code INFO -B Remitted Service Request # Invoice# Permit ID# , (fz.at vZs �0 /oa•�l S 5 1 4202-001 - - - - - ONSITE WASTEWATER PERMIT 1/21/2003