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LAME USE: APPLICATION It PERC TEST (S) NUMBER <br />LAI< PROM <br /> <br />SAN JOAQUN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE - 3- Ft, - STOCKTON CA 95202 - (209)468-3420 <br /> <br />O. • • • P. • ill •••••s• ••••,••11,1,1,C, • 11...•••••••• OA IL ISSU ED <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />NON-REFUNDABLE PERMIT' I- ALL WY/ VI:LI-FOY I OH AsELL ity.7. <br />,f4 A 4rt.,4 cavizip Cer.10 <br />fc,r7 b`a APN "7 • •00 ° PARCEL SIZE <br />PHONE <br />OWNER ADDRESS CITY/STATE/ZIP <br />CONTRACTOR 44014" PHONE <br />CONTRACTOR ADDRES -74- "7/ (11' 04210410d CITY/STATFAIP <br />Numsr.411 . EXPIRATION DATE /0 —19 LICENSE -42 U C-)6 OTHER <br />WATER TABLE DEPTH: /CO ft GEOGRAPHICAL INFORMATION: Coordinates X <br />LEACH LINES <br />FILTER BED . WIDER ft LENGTH <br />DISTANCE TO NEAREST WEI E. <br />ft LENGTH <br />WELL <br />It PROPERTY LINE <br />ft DEPT)! <br />11 PROPERTY LINE <br />MOUNDED WIDTH <br />DISTANCE TO NEAREST <br />ACHING CHAMBERS /G--- Cent/ ek •74-$ it OF LINES 3 <br />DISTANCE TO NEAREST WELL /tarp 1. ft FOUNDATION /6 r <br />ft FOUNDATION <br />ft FOUNDATION <br />LENGTH or LINES / <br />It PROPERTY LINE <br />DEPTII <br />3 SAND OIL SEPARATOR (ENCLOSER SYSTEM) <br />NtMUNI 24 HOUR <br />CE <br />t•) <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />TYPE OP WORK: NEW INSTALLATION 41W1K-REPAIRJADDII ION 0 ENGINEER DESIGNED )ALTERNATIVE <br />REPLACEMENT DESTRLICIION <br /> <br />INSTALLATION WILL SERVE: esu PENCE Commt: CJAL <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />TYPE/MEG • r_54s,...1 <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL ft <br />SIZE TYPE OF PUMP <br />SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />DISPOSAL PONDS WIDTH ft LENGTH <br />DIST ANCETO NEAREST WELI. ft FOUNDATION <br />SEEPAGE PITS WIDTH :3' ft LENGTH <br />OTHER <br />UMBER DE EMPLOYEES: <br />SEPTIC TANK <br />CI GREASE TRAP <br />PKO TX PLANT <br />ID LIFT STATION <br />CAPACITY gal SOP COMPARTMENTS <br />CAPACITY gal *OF COMPARTMENTS <br />FOUNDATION It PROPERTY LINE 11 <br />ft DEPTH <br />it PROPERTY LINE <br />ft DEPTH <br /> ft PROPERTY LINE <br />ft DEPTH <br />FOUNDATION ......Vre) ft PROPERTY I INF_ DISTANCE TO NEAREST ATLI. <br />I HEREBY CERTIFY —THAT I HAVE PREPARED THIS APPLICATION AND THE WORK MEL BE IRENE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES <br />STATE. LAWS AND RULES AND RECELLATIONS OF SAN JOAQCIN COUNTY. <br />SIGNED <br />. oTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)5534697 <br /> TITLE DATE y- <br />_Lex t <br />111101 P Quit,/ <br />75 taqv <br />Elogot MEIVIAL PIEA <br />Ares (2-- Employee <br />4,91 <br />0 SPECIAL PERMIT - Approved by <br />PR/Sump Sell acter: <br />g'4 .15 11-71. COMMENTS 615 • 0. <br />aop/S...f.611.edrashego i747-27.1str?,*, <br />PE <br />Cade <br />SC <br />INFO <br />Received <br />By <br />4..;eci..„(ir) A1/ Mau 0 <br />OHIO Remlit.cd ir Ser. (PcoRtiti uest 11 Invoice it Permit ID* <br />17102)/ I f c. 1.1 - — — c f 3 63 i I 0 gym <br />.1 <br />Application Accepted B <br />Final Inspection By <br />Character of Soil to De It of 3 Ft: <br />d' I <br />41)'' e <br />DEPARTMENT 15 0 V <br />Data <br />at iikenimai itget <br />36tiz&ele_442 <br />irbozort3 ap4/ <br />42-01-001 oNsiTE WASTEWATER PERMIT 1241,02