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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HFALTII DEPARTMENT 304 E WETTER AVE.-3-Ft.-STOCKTON CA 95202 -(219)46&3420 <br /> NON-REFUNDA CALL.(209)953-7697 FOR CTIONS A &XPIKESVEARJWC1M­1ftA1E BSUED <br /> JOS ADDRESS CrTYJZIP ' <br /> CRos":STREET APN PAR L SIZE <br /> 0 <br /> t� yy e <br /> OW'.rFR NAME N2d�— 7 + O PUONE <br /> 56 <br /> 157 OWNER ADDRESS CTI'4'1STATE/ZIP _,n <br /> CONTRACTORPAVQ-51A8S PRON <br /> CONTRACTOR ADDRESS ' CITY/STATE/ZI <br /> LICENSE C-42 ❑C-36 OTHER _ _ NUMBER EXPIRATION DATE <br /> WATER TABLE DMII: ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> ❑ PERC TEST # BUILDING PERMI+T�#.__ LAND USE APPLICATION#" <br /> TYPE OF WORK- ❑ NEW INSTALLATION / - REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: W RESIDENCE ❑ COMMERCIAL ❑ cirifrit <br /> NCMaER OF LIVrNG UNITS: 1 NL'MDF.R OF BEDROOMS: pJ NUMBER OP EMPLOYEES: V 1 <br /> ❑ SEPTIC TANK TYPFJMFG_ __ _ CAPACITY gal #OFCOMPARTMENTS J <br /> ❑ GREASE TRAP TYPFIMFG_ CAPACITY gni #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST; WELL R FOUNDATION.__ ft PROPERTY LINE 1 <br /> ❑ LIFT STATION SIZE TYPE OF PUMP L3SAND OIL SEPARATOR(ENCLOSED SYSTEM) 1 1 <br /> LEACH LINES X LEACHING CHAMBERSRD.�/� (5 1/ #or Lwrs�I LENGTH OF LIVEs v ft <br /> DISTANCETO NEAREST U'ELL�n R FOUNDATION — t ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH _ft DEPTH ft <br /> DISTANCE TO NEAREST WF-I-L ft FOUNDATION ft PROPERTY LINE ft_ <br /> ❑ MOUNDED WIDTH_ ft LENGTH It DEPIH ft <br /> DISTANCE TO NEAREST WELL_ It FOUNDATION _ ft PROPERTYLME ft <br /> ❑ SUMPS WIDTH ft LENGi4_ ft DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION _ _R PROPERTY LME R <br /> ElDISPOSAL PONDS WIIrrR _ft LENGTH--_ ft DEPTH It <br /> DISTANCE TO NEAREST WELL it FOUNDATION R PROPP.RTY LINE_ fl <br /> SEEPAGE PITS NuNBER t WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION R PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND TRE:YORK WILL.RF.DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS IONS OP SAN JOAQUIN COUNTY. <br /> ` 4JMIN N DJy'�ONCE VUTICE RF. LIP.F.D FOR I� T1fY\ti-PI. ASF'CALL(_09)953.7697 <br /> SIGNS(�` v �V�+�-� Q Tl'I'LTc„J �� ' DAT J <br /> 0 <br /> P1 I <br /> qkv <br /> 1 <br /> x <br /> IN <br /> V1 ac, M <br /> ILL <br /> DEPARTMEN�T11 F.ON <br /> Application ue B _ DRtC 1 Q_[Jam . Arra ,L Employee IDfi V4 <br /> final <br /> Final In o Date_'•�J�- _®��?Or� ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to De h or 3 Ft: PiUS'ump Soil Character:- <br /> COMMENTS D�L7 <br /> _fir• _ — _ <br /> PE Sc Re civcd Checidf! Amouat <br /> Code INFO BY Remitted Date Service R ueu M Invoice N Permit ID4 <br /> 3 c a 32 9 <br /> 52-02-001 ONSITE WASTT.WATER PERMIT <br /> 121-2112003 <br />