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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOAAN couurf ENVIRONMENTAL HEALTH DEPARTMENT 000 E MAIN STREET-STOCKTON CA 95202-(209)4SR"2420 <br /> NON-REFUNDABLE PERMIT — CALL. 209'953-7697 FCR 1NSVECTIOP,s EXPIRES I YEAR FROM DATE ISSUED <br /> JC*%ADDRESS_i D I -:�I C. /,b I-S? CITY2r 11 C A 1AA,Q D `-)C 1-ZU A <br /> CR OSS SR EET f�JLJ4 APN_ O1'1 - )D O' I Z_ PARCEL`��ZSI�E 5 &C <br /> ER ill T <br /> $$�T <br /> OWNN.Aw J�PQ (LSPHONE�OR ' Tui'S�3r'�- lq <br /> OWNER ADDRESS _I o l�i t. RchmPa (L-D CITYISTATE2IP _l,�f{1'N'LT O C^ q1;--z-TC) <br /> CONTRACTOR L•I�/E DAtK Gof�1y 1{� N w1ElJin� PHONE_ �'�"�1f�')-IJ/�� <br /> CONTRACTOR ADDRESS _ {.V' D �- rQ <br /> CATYISTA IElZP LoD L [A RS 240 <br /> LICENSE -C42 _?Cd8 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X -�-- y <br /> PERCTEST •-�--� BUtLDiNG PERMIT IR--________ _ LAND USE APPLICATION�{ yy)---yy� ' <br /> TYPE OF WORK: ❑ NEW WSTALLATXMI ---..-_-_ -- - --�G'f.�t- /i£� '> <br /> REPAIRIADDITION ENGNEER DESIGNED IALTERNATIVIE (� <br /> G REPLACEMENT f: DESTRUCTION <br /> E: <br /> IINSTALLATION WILL SERV ❑ RESIDENCE CI CONIWRC3A1. OTHER <br /> - NUMBER OF LryING UNITS: NUMaER OF CEORD MS: NUMBER OF EMPLC?/EES �O <br /> O SEPTIC TANK TVPk1MFG --.---.--_.'-__ CAPACITY_- gat SOr CdM°uOARiMS �O <br /> ❑ GREASETRAP TrrO'MrC _-- _..------- CAPACITY -. 9M NORT <br /> FGCWAMENTs-- _ <br /> DISTANCETONEAREST. Wf:ILV <br /> _..__ ft FaXaprnc+:_---..._------ fl PRtxRRT•r LRa. <br /> ❑ Lif1'STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND CIL SEPARATOR(ENCLOSED SYSTEM) I <br /> ❑ LEACHLINES LEACHING CHAMBERS �+ fOFLINES LENGTHOFLUES-_ Q <br /> DISTANCE TO NEAREST WFLIft FOUNGIITS7NR PROPERIYLI`E_-- _ ft I <br /> ❑ FILTER BED WIDTH---__-_--R LENGTH .._R DEPTH_- it <br /> DISTANCE TO NEAREST WELL ft FOISAAT1014 R PROPERTY LINE _ft <br /> ❑ MOUNDED Wn] _ ft LENGTH___- ft DEPTH_-_ _R <br /> DISTANCETONFARFBT WELL ft FOINDATIDN_ __ft PROPERt1'IJNE___ ft <br /> Q SUMPS WIDTH -----.- ft LENGTH _ft DEPTH_._. ft <br /> DIS TANCE TD N EAREST WELL ft FCRINDATION_ ___R PROPE RTY LINE_ ft <br /> ❑ DISPOSAL PONDS W.TH_____-_ ft LENGTH --___ R DEPTH__ -_-__-__ft <br /> DISTANCE TO NEAREST WELL i ft FOUNDATION -,_—_R PROPERTY LINEft <br /> ❑ SEEPAGE PITS NUMBER N7aTH-- -ft DEPTH,-_ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION -ft PROPERTY LR'E ____ ft <br /> i HEREWe CERTII`Y THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WLL BE DONE IN ACCORDANCE HATH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOACULN COUNTY. <br /> 1:R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.769 <br /> SIGNED_ TITLE [gNSVL')"tt►JT _ DATE <br /> L-1- - - I I_.._ - ..... _ _L I I I- - -- <br /> Fizee- <br /> _ � I <br /> I �•- II <br /> �_-�. 1 �� "Q- `ter r ° <br /> PAY PA E=NT <br /> RECEIVED <br /> I <br /> o AUG 15 20H <br /> a00000000000000 00000o A <br /> 000000000000000 000 <br /> =�A------�- - 1. SAN JOAQUtNCOUNTY <br /> ENVIRONMENTAL <br /> L_1_ I I JAI I F IFALTH DEPARTMENT <br /> ffuA3 <br /> DEP TMENT US ONLY Applfcatfon Acc � Area Cj j EmploTee lDltFlnai lnspecltonH � CJ SPECIAL PERMIT-Approved by <br /> Character of So:I to jPIVSumpSo11Character_COMMENTSC) <br /> �'�7i ems. _ __�—�_�—� /N/.•-�1....) <br /> PE SC Received Amount Perm H! <br /> Code INFO B 'Cash Date Invoice s PermIt ID* <br /> �j Remltte ervfce R uesi s <br /> i I <br /> 13.a <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMrr <br /> 1014107 <br />