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GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # /121ca226 / LAND USE APPLICATION # <br />te/ <br />/0 6c' <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE - 3 FL STOcKTON CA 95202 - (209)468-3420 <br />NON-REFUNDABLE myr <br />JOB ADDRESS , <br />CALL (2" 953-7697 ro,) I nu. EcrioNs <br /> CITY/ZIP <br />PIRES 1 YEAR FROM DATE ISSUED <br />CROSS STREET <br />OWNER NAME <br />OWNER ADDRESS <br />CONTRACTOR <br />c11444 gr./ APN DpS": /60 --.13 PARCEL Sin 141C- <br />OeLlAisi-- PHONE 339 V‘Ie <br />3 A1.0 <br />CITY/STATE/ZIP e <br />CITY/STATE/ZIP CONTRACTOR ADDRESS idp.04(.4a,6- <br />LICENSE -42 0 C-36 OTHER NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: I DC <br />PERC TEST # <br />TYPE OF WORK: 11.. NEW INSTALLATION <br />REPLACEMENT LI <br />0 REPAIR/ADDITION 0 ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />tillESIDENCE 0 COMMERCIAL <br />NUMBER OF BEDROOMS: <br />0 OTHER <br /> <br />NUMBER OF EMPLOYEES: <br />Oil( SEPTIC TANK TYPE/MK adleee-6714-"" SCCA3-44— CArAcrry <br />GREASE TRAP TYPE/MFG CAPACITY <br />PKG TX PLANT DISTANCE TO NEAREST: WELL '12 An ft FOUNDATION <br />Mp ..40e),DI,N4451j, SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES ALLEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL <br /> 3(ft <br />FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />MOUNDED %vim <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL <br /> <br />ft FOUNDATION ft PROPERTY LINE <br />SEEPAGE PITS NUMBER <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 />SIGNED <br />/3407 r, MIN M 24 HO R ADVANCE NICTIZEQUIRF:D FOR INSPE <br />505 s ITITLE <br /> IONS - PLEASE CA1.1, f200) 053-7697 <br />/a5-7,o gal # OF COMPARTMENTS <br />gal SOP COMPARTMENTS <br />/0 , ft PROPERTY LINE 1. 40 Ft <br />LIFT STATION SIZE TYPE <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />SUMPS WIDTH ft LENGTH <br />DISTANCE TO NYREST WELL ,e2 ft FOUNDATION <br /> WIDTH 3 <br />ft FOUNDATION ft PROPERTY LINE <br />ft LENGTH ft DEPTH <br /> <br />FOUNDATION 1 e ft PROPERTY LINE /0 <br /> <br />ft DEPTH <br />S OP LINES 4:2,a LENGTH OF LINES qe, <br />ft <br />ft <br />11 PROPERTY LINE <br />DEPTH <br />DEPTH <br />ft PROPERTY LINE <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />DATE <br />pp,N(MEN I <br />P EC ENE D <br />de <br />M( 1 6 Zeit% <br />6,16411/ <br />-RV <br />\441 <br />sArl JO tE <br />" H DEFARTMtra <br />wed <br />MAO m 40.4 e <br />Application Accep <br />Final Inspection <br />Character of Soil to <br />COMMENTS <br />• <br />PE SC Code InFo Received decicglhdfl Amount By Remitted Date Permit,/ Service Request # ,,_-..,- Iron* # , ; _ Permity)H*.„) <br />424I ( II- is.1.--- 733-S— 44'316) 71610,1a:Sieb0 46 71 ) ,`,>-' -4-•- ,,, .-7-'..--.- - ,.-,- <br />/-"" "-LN. ,•":"" ---r... - 2"1, IV <br />42-02-001 <br />12/22/2003 <br />ONS1TE WASTEWATER PERMIT <br />4" 7 <br />DEPARTMENT SE <br />Date Area <br /> <br /> Date 1:1 SPECIAL PERMIT - Approved by <br /> Pit/Sump Soil Character: c::- e-, <br /> <br />/.r L..' - <br />Employee ID# .53660