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F.L"- ONSITE WASTEWATER TREATMENT SYSTEM PERMIT /542 <br /> "�NSE <br /> QUIN COUNTY ENVIRONMENTAL.HEALTH DEPARTMENT 304 E WEBER AVE-3YO FL-STOCKTON CA -(209)468-3420 <br /> EFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECT IONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> RESS %Ci1(J7 L- �6L7�>£/1 / CrrY/ZIP <br /> Q r /� <br /> REET IE'(�'J/�7/1�4 /.G-�2�'J/ AP�i rIO��%�D �� PARCEL SIZE <br /> AME Keh tAlYI(JT PNONE <br /> DDRESS S/�N^� CITY/$TATFII.IP p <br /> TOR PHONE <br /> TOR ADDRESS 1 t: CIT\'/STATFJZIP <br /> - C-42 ❑C-36 OTHER `UMBER E%PI RATION DATE 7/G-' <br /> WATER TABLE DEPTH: ft GEOGRAPHICALINFORAIATION: Coordinates X Y <br /> ❑ PERC TEST # I MIT PER # _Q Q _ LAND USE APPLICATION# <br /> TYPE OF WORK: ? NEW INSTALLATION U REPAIR/ADDITION L3ENGI\EER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL. ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUNBEROFEm PLOVEES: <br /> SEPTIC TANK TYPE/MFG CAPACITY Oil gal #OF COMPARTMENTS _y-2 <br /> ❑ GREASE TRAP TYPE/MFC, CAPACITY gal 0 OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETO NEAREST: WELL R l'OCNDATION �.5 Il PROPERTY LINE —2007'/— R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> E3 LEACH LINES Ck LEACHING CHAMBERS OF LINES 7 LENGTH OF LINES ' ft <br /> DISTANCE TO NEAREST WELL 11�_R FOUNDATION PROPERTY LINE ADO R <br /> FILTER BED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCETO NEAREST WELL tl FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH fl DEPTH ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION R PROPERTY LINE_ R <br /> ❑ sumps WIDTH R LENGTH R DLPN/ ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH_ R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER Z WIDTH 3c, R DEPTTHI 0 ft <br /> DISTANCETO NEAREST WELL /SS�_ fl FOUNDATION _�rj R PROPERTY LINE Z42F;4 ft <br /> I HEREBY CERTIFY THAT I HANE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RLLES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> Nt IN IAIUNI 24 HHOt R�%DDV'ANT E NOTICE REQUIRED FOR INSPF.CI IONS-PLF.%SE(ALL 1209)457-761)7 <br /> SIGNED -995ik�—ze� TITLE Gjj DATE_y�ZO7 <br /> -7 <br /> a S <br /> -/ r f-P-5 <br /> /J <br /> 'Tl PlMl A 13, <br /> - <br /> A T <br /> R2L <br /> c <br /> Application Arc Dale •� Area Employee ID# <br /> Final lnspectio By__ / Date y��//J� ❑ SPECIAALLPER,I IT-App%by <br /> Character ofSoll to Depth o 3 Pt: �i/-� 'Pit/Sump Soil Chancte <br /> COMMENTS i k <br /> PE SC Received / Amount Date Permit! Inv a Permit 1D$0Code INFO B ash. Remlited Service R ues[8 <br /> Clll� A 1.5161r L <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/222003 <br />