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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT
<br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET - STOCKTON CA 95202- (209)46a-3420
<br />NON-REFUNDABLE PERmIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED
<br />JOB ADDRESS gin 3 6. 1-in-Kue•&t . RvoviL ciTyatt• 11-c1-mp01 CA 95 2M1
<br />CROSS STREET ki/o/ r-voed-ftle, I2e,441/2 ApN 7-40.10 010 PARCEL SIZE
<br />OWNER NAME R () he, 4- L . St) 4 Mi;r47 kN4pfl PHONE .90 t 7I'V-s8v7
<br />OWNER ADDRESS /?(O giv Pj 400-10 ciTy ATEIzip =-547r Ft3 64-95"
<br />Own Git- PHONE
<br />CONTRACTOR ADDRESS CITY/STATE/ZIP
<br />LICENSE U C42 0 C-36 OTHER NUMBER EXPIFrATION DATE
<br />WATER TABLE DEPTH:
<br />
<br />ft C,EoGRApH !CAL INFORMATION: Coordinates X
<br />
<br />BUILDING PERMIT #J i ,D4fd, .c7t,:: LAND USE APPLICATION
<br />
<br />PERC TEST *
<br />
<br />TYPE OF WORK: 0 NEW INSTALLATION 74-REPAIR/ADDMON ( 3 Po-4,0 DESIGNED IALTERNATIvE
<br />0 REPLACEMENT U DESTRUCTION
<br />
<br />INSTALLATION WILL SERVE: **RESIDENCE 0 COMMERCIAL U OTHER
<br />
<br />NUMBER or LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES:
<br />tIC
<br />SEPTIC TANK TYPE/MEG S •-•,-/'.LE-7 cAractrt / )—gt; vtl # OF COMPARTMENTS 2---
<br />GREASE TRAP TYPEADG CAPACITY gal 4 OF COMPARTMENTS
<br />DISTANCE TO NEAREST: WELL S 0 ,A4 'S- . ft FOUNDATION ft PROPERTY LINE ft
<br />CONTRACTOR
<br />LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT U SAND OIL SEPARATOR (ENCLOSED SYSTEM) MMIMV 31115 0 LEACHING CHAMBERS 4 OF TINES 3 LENGTH OF LINES 4-0 ft ‘,..
<br />WELL ,.--,.0 — •- Ft FOUNDATION ft PROPERTY LINE ft
<br />ft LENGTH ft DEPTH ft
<br />NA)
<br />WELL ft FOUNDATION ft PROPERTY LINE ft
<br />ft LE.NCTFI ft DEPTH ft rh —
<br />DISTANCE TO NEAREST WELL ft FOUNDATION
<br /> DEPTH
<br />ft PROPERTY
<br />LINE
<br />ft
<br />SUMPS wiont ft LENGTH ft ft
<br />DISTANCE TO NEAREST WELL Ft FOUNDATION ft PROPERTY LINE ft
<br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft
<br />DISTANCE TO NEAREST WELL ft FOUNDM ION ft PROPERTY LINE ft
<br />pr„ SEEPAGE PITS NUMBER 3 %tyro , 3 ft DEPTH ;:‘,.- Ss ft
<br />DISTANCE TO NEAREST WELL f C.: 0 -44 . -'-ft :'0UNDATION ft PROPERTY LINE ft
<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 />_CD- A
<br />M USIA 11OUR4ADYANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209)953-7697
<br />TA SSC
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<br />IN .00' SSC
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<br />..yie...s. nom• noxprga my t"-- Date I -2- ii 1/6 7 Area */17
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<br /> Employee ID* 5 3 6t,
<br />Final Inspection Hy .......- ?,,estmo,..........,r-/ Date .q,-WCI 0 SPF.21.L.ce,. PERMIT -Approved by ..,_
<br />, 174-41
<br /> Pit/Sump Soil Character: -f-t Co'reolt.." Character of Soil to Depth of 3
<br />COMMENTS O L. ,.) Lo7 - c. F 4,-ie 6 .0 er, „Le-- ..- ' , „-}"" .--5 ....,-,,-- .„(.05.e..
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<br />PA
<br />Code
<br />SC
<br />INFO
<br />ReceivedCIrt--
<br />By
<br />Amount
<br />Rem Date itted
<br />Permit/
<br />Service Request S ...e..... In • trial 130 ,,,,.
<br />Cash
<br />42-1C.' I i -5 VI 1 I9 It OL3C' r i‘- kytyrol settles.T.5-v
<br />42-CI OF/SITE WASTEWATER PERMIT
<br />LEACH LINES
<br />DISTANCE TO NEAREST
<br />FILTER BED WIDTH
<br />DISTANCE TO NEAREST
<br />MOUNDED WIDTH
<br />7'7
<br />A. 1..• ;
<br /> 6Av
<br />Af fr,,,kcium,
<br />triy 0,4\14114k A4rvri.
<br />137.41Enor
<br />/ 7
<br />0 E • r 0
<br />7
<br />ID
<br />05)30/2007
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