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APN lit ith,-/50),, <br />i 5 CITY/STATE/ZIP <br />CONTRACTOR ADDRESS '7,Y1) E JAexty CITY/STATE/ZIP <br />NUMBER _VS-9e,, EXPIRATION DATE LICENSE U 0-42 CI C-36 OTHER <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />PERC TEST BUILDING PERMIT Ot C• e- cigs yLAND USE APPLICATION St <br />TYPE OF WORK: id-, NEW INSTALLATION 0 REPAIR/ADDITION 0 ENGINEER DESIGNED /ALTERNATIVE <br />0 REPLACEMENT DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: PA-RESIDENCE 0 COMMERCIAL <br /> <br />NUMBER OF LIVING UNITS: J NUMBER OF BEDROOMS: <br />0 OTHER <br />NUMBER OF EMPLOYEES: <br /># OF COMPARTMENTS <br />PROPERTY LINE )0 ft <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) LIFT STATION SIZE TYPE OF PUMP <br />gal <br /> gal <br />ft <br />a SEPTIC TANK TYPE/MFG hz CAPAcrry je,e,e) <br />GREASE TRAP TYPE/MFG CAPACITY <br />PKG TX PLANT DISTANCE TO NEAREST: WELL t ft FOUNDATION .PS- <br /># OF COMPARTMENTS al <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER Ave - 3c FL - STOCKTON CA 95202 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />OWNER ADDRESS <br />CONTRACTOR <br />z://75- c c- r • <br />dorytc,s ,OrF <br />3110D 6. 6.filf gd c)-e 6 <br />CITY/ZIP /3r- Arnfk, (16 <br />ec,5-----vz)- 0 .7 PARCEL SIZEgrepti-- <br />. . <br />PHONE <br />PHONE —3t;'3 -SZZ <br />Pit/Sump Soil Character: <br />E--,4 "--4 1-4 Ltc..7-4c /0 C 7 c> <br />Character of Soil to Dep of 3 Ft: <br />COMMENTS F c c. <br />c L 7 <br />42-02-001 <br />12/2212003 <br />ONSITE WASTEWATER PERMIT <br />T <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Ch <br />Cash , <br />Amount <br />Remitted <br />Permit/ Date Service Request ii Invoke 8 Permit 11:10 <br />q ? / I ? I -7 Z-C- If 41-50 - f 4-5-'' '71) tk3 i°1--7-,420 .1), 3 3 9' _._ <br />Area Employee IDS .5 3 (de• <br />0 SPECIAL PERMIT - Approved by <br />Application Accepted B <br />Final Inspection By <br />DEPARTMENT <br />Date 't <br />Date :SS3Z1OOV 311S IC LEACH LINES 0 LEACHING CHAMBERS S OF LINES y LENGTH OF LINES 90 ft <br />DISTANCE TO NEAREST WELL igc.0-.. ft FOUNDATION e,,5-' ft PROPERTY LINE 7 ' n <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />DISPOSAL PONDS WIDTH 11 LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION tl PROPERTY LINE ft <br />V -36 " ft DEPTH dc . ft 13- SEEPAGE PITS NUMBER WIDTH <br />7' DISTANCE TO NEAREST WELL /.6!)- ft FOUNDATION iDe) ' ft PROPERTY LINE <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORDINANCES. STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED Ade. ..01-4 TITLE DATE 0 <br />ilk, • Z.4„ <br />1111111111114M11111111111111111111111111111 <br />MIIIIME111=1111111=111Mti. 1111111M1111111111•11111EMMEMENINIIIIIIME <br />1111111111111111111111111 F° (2, I IN 0 N