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, 3J <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL FI VALITN DEPARTMENT 304 E WEBER AVE.-3"FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT (3 �QCALL(209)953-7697-FOR I%SPEC'TIO%S ' — EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �O /l LE . CITY/ZIP I i iTe ` • / 91�3 3 0 Z <br /> CROSS STREETM (I el ry APN L0 PARCEL Z 4G c <br /> OWNER NAMNAMEGx4"r.'L PHONE X047 -5 72 /lfory <br /> ql /XQ�G✓� � <br /> 77 <br /> OWNER ADDRESS Q J W f eta x y CITY/STATE/ZIP � /C� C,+ y S�3 o <br /> l 4 [, <br /> CONTRACTOR '— U _ <br /> ME I. PHONE O L—S7/v 2— <br /> CONTRACTOR <br /> CONTRACTOR ADDRESS _ .j _ CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL.INFOKMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# 070---11 2—LAND USE APPLICATION# <br /> TYPE OF WORK: 1W NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENG(NEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT - _ ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: (RESIDENCE ❑ COMMERCIAL ❑ OTHER - FF <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOI'EES: A ' <br /> SEPTIC TANK' TYPE/MFG 1 D CAPACITY ZOO gal #OF COMPARTMENTS 2- <br /> GREASE TRAP TYPE'MFG 7 CAPACrTY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION R PROPERTY LINE ft <br /> ]] t <br /> ❑ LIFT STATION SIZE 4. TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES X LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft '•, <br /> I DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ FILTER RED WIDTH I R LENGTH R DrPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R .� <br /> ❑ MOUNDED _ WIDTH R LENGTH R DEPTH _It <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH 1 R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R N <br /> ❑ DISPOSAL PONDS WIDTH 1 R LENGTH R DEPTH R fU <br /> DISTANCE TO"'EAIREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER 1 WIDTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> 1 q <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> caY.JOA01'IN COUNTY. - <br /> a <br /> SIGNED ...b !✓yrs <br /> E%191416 <br /> r rvI,irk" I r <br /> - I .' R TrIKMy G1 II <br /> 4;r AEOT <br /> ,3V(T Pu1dE9 <br /> ,AE °PAY <br /> RECEIVET I <br /> o <br /> MAY 2 5 20 7 <br /> SAN JOA U� �. <br /> 19' b'.5' Is' I ENVIRONMENT <br /> - <br /> p <br /> Application Accepted By ''Date S` �•s O Area Employee ID# <br /> Final Inspection ByDate l/ 7 L.if 11SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: - IUSump Soil Character: <br /> Il COMMENTS OLD L.D- r,F <br /> D <br /> �p[di /Lir7.u�� 4�e Zll-j RR£crfb- <br /> PE SC Received Amount Date Permit/ ^` _Invoice# Permit ID# <br /> Code INFO BY Cash - Remitted Service Request <br /> 42-•13 (I K SD 50-ITV S b7 �<50 <br /> 1 <br /> A2-02-DDI /120 eY,Gs/�� in / �• ��/� iU i2.e���rl- J.v¢�0, S i /_ �_ /J)yl ,d'//r 4AVNSITE WASTEWATER PERMIT <br /> 1 ` 1222/2003 _r /hwfv urccPt 3s s� sAC l6/ac r J n/1• rcf/i/��Jr!� c9c <br />