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v <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT' <br /> SAN JOAQUIN COUNTY ENVIRONMENTAI.HEALTH DEPARTMENT 304 E WEBER AVE-3'"FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 20 951-7697 FOR INSPECIIONN XPIRES 1 YEAR FR YI DATE ISSUED <br /> • . �`T.. tG7 /�� CITY/"LIP .i <br /> JOB ADDRESS - <br /> CROSS STREET Q-I--J- - .APN�� D0 PARCEL SIZE._� e <br /> OWNER Nnnle _�Ll1�LL...�r PROSE_ <br /> OWNER ADDRESS _ `/!r_._(�� •�_ .Cr CI'fYl$TAI'k'1ZIP �[ 71 zr+ <br /> CONTRACTOR <br /> CONTRACT ORADD HESS 7 CITY/STAT F/ZII' _ - <br /> LICENSE. '-02 ❑ -3 O7fIER _ _ NUMBER E%PIRATION DATE ,n-`Y <br /> WATER TABLE DEPTH: _I) GEOGRAPHICAL INFORMATION: CoordlnAt" X Y <br /> ❑ PERCTEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSrALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACI.NIENT ❑ DFSrRUn lON <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OrDER <br /> NI MRER OF LIVING UNITS:_ NUMBER OF BEDROOMS: 3 N umom OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEiMFc_ CAPACITY gal #OFCOMPARFMENTSF� <br /> ❑ GREASE TRAP TYPE/MI'G_._ CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCETO NEAREST: WELL R FOUNDATION Fl PROPERTY LINE Fl wr <br /> ❑ LIFT STATION SIZE TIPEOFPUMMP ❑ SAND OIL SEPARATOR(ENCLOSED <br /> �SN'STTEM) <br /> XL (Il1y�� <br /> LEACH LINES LEACHING CHAMBERS e7 le"s,��_ #OF LINES LENGFIT OF LINES <br /> DISTANCF.TONF.ARFST WELL Qit FOUNDATION_f_, 2_A PROPERTY LINE �C-/ fl <br /> ❑ FILTER RED WIDTH ft LENGTH_ ft DEPTH _fl <br /> DISTANCETONEAREST WELL __It FOUNDATION ft PROPERTY LINE _ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE H <br /> ❑ SUMPS WIDFH Fl LENGTH Fl DEPTH ft <br /> DISTANCE TO NEAREST WELT ft FOUNDATION (( PROPERTY LIKE. fl <br /> ❑ DISPOSAL PONDS W'IDTx ft LENGTH__ _ft DEPTH 0 <br /> DISTANCF.TONE REST WELL It FOUNDATION H PROPERIINN'L� _fl <br /> SIC SEEPAGE PITS NUMaE _ : <br /> WIDTH _It DEPTH J 7 <br /> DISTANCE:TO NEAREST WELL. H FOUNDATION H PROPERTY LINE <br /> I HEREBY CERT'IF)'THAT 1 HAVE PREPARED THIS APPLIUA"IION AND FHE WORK)Fill.BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNT) <br /> ORDINANCES,STATE.LAW'S AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> (- MIN 1124 H( R%I .5\(F VO�]/110E LIREII I-OR IWIFC'f NS-PLEASE CAI.I.('_119)451-7641 <br /> // <br /> SIGNED /wwe� O�df171.l;_ DATE OJT' <br /> i <br /> 7-1 ii <br /> !I <br /> a L <br /> i <br /> s <br /> DEPARTMENT SE O .Y-- <br /> .Application Accepted Date 13 Arca _ Emplovee IDE+ <br /> Final Inspeclio By -�� ___ Dwe�! V ❑ SPECIAL ERMIT•ApprovedbyII <br /> Character of Soil to De th of 3 Ft• Pit/Sump Soil Character <br /> COMMENTS <br /> 444 <br /> Av�,rr� <br /> �i�ii lam'—v��c �r�` .�'L_cxa- ! �'+ �/ .cZ._-�s�'m .1.✓'a' '72` <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit IDN <br /> Code INFO By as Remitted Senice Re It# <br /> 3-t 0 <br /> 42-02,001 ONSITE WASTEWATER PERMIT <br /> 12^_21:007 <br />