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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL.HEALTH DEPARTMENT 304 E WEBER AVE -3`°FL-STOCKTON CA 95202 - (209)465-3420 NON-REFUNDABLE PERMIT CALL 209 953-70997 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 700 1.�eSf M oss '4/E- Kq/ CITY/ZIP L/r IiV/DP CROSS STREETS' APN J j 0.3(20 PARCEL SIZE P/3 v v ^ 12- Pilo r a OWNER NAME "Tp - lrr �l/ � �y1NE OWNER ADDRESS C) F�o �D CITY/STATFJZIP CONTRACTOR -q'Jo ev PHONE 2JcT P'�� lJ CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE /3/ Oh WATER TABLE.DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: FY NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE. ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL. ❑ OTHER O NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 1NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG %1? P�I__�_ CAPACITY 0 U gal #OF COMPARTMENTS 2— ❑ GREASE TRAP TYPE/MFG AA CAPACITY gal #OF COMPARTMENTS f LJ PKC TX PLANT DISTANCE TO NEAREST: WELL r ft FOUNDATION— III PROPERTYLINE I V t ft ` ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) 3 ❑ LEACH LINES 0 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL R MFOUNDATION ft PROPERTY LINE R FILTER BED WIDTH I ft LENGTH TT ft DEPTH DISTANCE To NEAREST WELL 1\* ft FOUNDATION Iy R PROPERTY LINE f 0 + R ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft 1 17 DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE To NEAREST WELL R FOUNDATION R PROPERTYLINE ft ❑ DISPOSAL PONDS WIDTH R LhNGTH R DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATION f1 PROPERTY LINE R ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 24 HOUR ADy'ANCF:NOTICE.REQUIRED FOR INSPF.Cl101SS-PLEASE:CALL.(2091`153.7697 SIGNED TITLE C011,1-9 DATE X— N r-zo doe BEGINNING OF SLOPE 10' 7.FORTDLSTMU ION BOX i SO / 50' p. s TF — 140 INFILMATORQIAMBEAS 10' 1 a rr 1 ° - ° ;=q 1 Trete+i Sbc Age OBSERVATION PORTS (t A R E A 26' --� PLANVIEW O IMOOAUM >Bf1C TANL �itl(-� N No SCALE 0 \\`O -EXISITW GRASS COVEMM ORADH 4-r SK)MY LOAM WM COV WIDtG ^ ,� CNAMBBR G y ..Ilnrlr WAHM IICOIIID '`�' G� v DEPARTMENT USE ONI. l QO p Application Accepted -- Date I L O Area Employe MFinal Inspection By Date 7 2Q L�7 ❑ SPECIAL PERMIT-ApproEQd Character of Soil to De of 3 Ft: Pit/Sump Soil Character: COMMENTS �+� N i+�n m� EJ4D � C oco� r�n —S J^�f l�Ql� > 2e[>r D' 7D i .� 3 SL'r'e•y5 4& JcbO-Q Al i.4 rILa*-MR, TV" _C,+0J0L;7- K yV;X:-'0 /rX1A,�` ,�'�ti S t\1 CU - P- E - p -a., •A-U- KVIL ta.= •r -• ��4%4 ,' 4-A. L JL " PE SC Received � Amount Date Permit/ Invoice# Permit ID# Code INFO By Cash Remitted Service R uest# 42-02-001 ONSITE WASTEWATER PERMIT 12'22'2003