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10 AFA <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3'°FL-STOCKTON CA 95202 -(209)469-3420 <br /> NON-REFUNDABLE PERMIT - CALL 209 953-7697 FOR INSPECTIONS EXPI $1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS { 310 F.�)Pt�at Pi'IJT 9—D, Crrv/zIP LO ae?Z�O <br /> TIA"y -P—D. APN O�3 i D Z- <br /> CROSS STREET�'D • � PARCEL SIZE p <br /> OWNER NAME (-,-el KJG J 1ON <br /> i.+ <br /> PP�HE' <br /> OWNERADDRESS C/ !WY�G" c CITY/SrATFJZIP <br /> CONTRACTOR 1�OR-T Fi�flL e- LA.tAl ZtJG. PHONE 'g- <br /> CONTRACTOR ADDRESS 0 CRY/STATFJZIP L-Opi, CA 11157-40 <br /> LICENSE III C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE Q <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# OY-6 2J N '2 LAND USE APPLICATION# �n <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION O V ENGINEER DESIGNED/ALTERNATIVE i <br /> O REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: 2 RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: �1']nII �,. ^NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> CII SEPTIC TANK TYPE/MFG flwl.frJl — 1'A-G CAPACrrY IiWO gal #OFCOMPARTMENTS (i V <br /> ❑ GREASE TRAP TYPE/MFG CAPACrrY gal #OF COMPARTMENTS <br /> t r r <br /> ❑ PKC TX PLANT DISTANCETO NEAREST: WELL t0O + ft FOUNDATION V5 ft PROPERTY LINE JD ft <br /> ❑ LIFT STATION SIZE TYPE OAGF PPUMP 13 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES U LEACHING CHAMBERS t�Q-3(0 X, 15 <br /> #OF LINES LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL I OO r•F R FOUNDATION 0 ft PROPERTY LINE 3 SOr <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> �d SEEPAGE PITS NUMBER—:1W. 3 J R DEPTH 25 r R <br /> DISTANCE TO NEAREST WELL IZp r+--ft FOUNDATION 1710' ft PROPERTY LINE �-IOr ft <br /> 1 HEREBY CERTIFY THAT i HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINI SUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL((209)953.7697 <br /> SIGNED s�.1/�a"1L•0 TITLE ( T�1`-' DATEIR as <br /> EINE <br /> rlht L <br /> nnAA H• o a lAl- <br /> V 1 ' 18 TAErr <br /> { I <br /> 1,71 <br /> V P <br /> —Tw4AX TI—LI <br /> DEPARTMENT US ONLY <br /> Application Accepted By e Q Area Employee ID# �� <br /> Final Inspection By - Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Qeltth 3 Ft: Pit/Sump Soil Character: <br /> COMMENT L/Gf!/ <br /> SO4y !/ 5 Wo, J <br /> PE SC Received AmountDau Parmltl Invoice# Permit ID# <br /> Code INPO B Cash Remitted Service R nest# <br /> R - VPlp �a <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 1222/2003 <br />