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Cf. 42-02-001
<br />12,2212003
<br />c,
<br />WASTEWATER PERMIT
<br />9 3 77
<br />ONSITE WASTEWATER TREATMENT SYSTEM PE IT
<br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER Ave - r" FL- STOCKTON CA 95202 - (209) 468-3420
<br />9 9 -7 97 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED _ . _ ..
<br />JOB ADDRESS --- 2: CITY/ZIP A-c 6 voiog
<br />6 ''' if.1////:._. Ly, ' APN on 0.2-02-0 PARCEL SIZE CROSS STREET
<br />OwNER NAME / ' RZ.-1=11, U 411 PHONE Pa..) r.< 2F,y
<br />OWNER ADDRESS C HA R 1/47- S7- RD a 01/1(sylsw.,z,, qc • il, ,
<br />CONTRACTOR ,/ ILL; XP_ZZ:Iffr_k_...______ PHONC_ 4/e .1‘C 6---(/ - .2f,"
<br />CONTRACTOR ADDRESS CITY/STATE/ZIP I
<br />Cl C-42 0 C-36 OTHER NUMBER EXPIRATION DATE I LICENSE
<br />TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y WATER
<br />0 TEST 4 PERC BUILDING PERMIT • BP -O67 2:2-7--LAND USE APPLICATION •
<br />TYPE OF WORK: LI NEW INSTALLATION LI REPAIR/ADDITION CI ENGINEER DESIGNED /ALTERNATIVE
<br />REPLACEMENT Z.- Ff3.1) Pi/A_ 0 DESTRUCTION ipc
<br />WILL SERVE: 0 RESIDENCE U COMMERCIAL U OTHER INSTALLATION
<br />]UMBER OF BEDROOMS: NUMBER OF EMPLOYEES: NUMBER OF LIVING UNITS:
<br />11 ' TYPE/MFG 60 CAPACITY ' 2-0 t gal 4 OF COMPARTMENTS SEPTIC TANK /Sweet
<br />CAPACITY gal 4 OF COMPARTMENTS 0 GREASE TRAP TYPE/MFG
<br />0 DISTANCE NEAREST: WELL 51) ft FOUNDATION ft PROPERTY LINE ft PKG TX PLANT TO _.,..--
<br />(.3 LIFT STATION SIZE TYPE OF PUMP LI SAND OIL SEPARATOR (ENCLOSED SYSTEM)
<br />0 CHAMBERS n OF LINES 2_ LENGTH OF LINES Y- 6 ft )11 LEACH LINES LEACHING
<br />DISTANCE NEAREST WELL p ft FOUNDATION (0 ft PROPERTY LINE 5- ft TO 5.
<br />ft LENGTH ft DEPTH It 1:1 FILTER BED WIDTH
<br />DISTANCE NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft TO
<br />WIDTH ft LENGTH ft DEPTFi ft IZI MOUNDED
<br />NEAREST WELL If FOUNDATION ft PROPERTY LINE ft DISTANcE TO
<br />WIDTH '',1 11 LENGTH i 2- ft DEPTH /r ft r•Sif- SUMPS
<br />NEAREST WELL (O ft FOUNDATION / 0 ft PROPERTY LINE c-- ft
<br />I DISTANCE TO ..S
<br />WIDTH ft LENG EH f: DEPTH ft Li DISPOSAL PONDS
<br />NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft DISTANCE TO
<br />WIDTH ft DEPTH 11 0 SEEPAGE PITS NUMBER
<br />NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft DISTANCE TO
<br />I HEREBY CERTIFY THAT
<br />MIN
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<br />) SIGNED t
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<br />I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY
<br />ORDINANCES ,_7AT E_ LAWS AND RULES AND REGULATIONS OF SANJOAQUI N COUNTY. , I s 24
<br /> TITLE
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<br />DATE
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<br />Date /5140 C„.• Area l / 7 /employee 11114
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