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16,5 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-311 FL-STOCKTON CA 95202 -(209)468.3420 NON-REFUNDABLE PERMIT(,t / CALL(209)953-769/y7 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS ..,1 �� I VExt'1: CITY /ZIP f^�-1,---f- CROSS STREET �`"✓�r'1� APN PARCEL SIZE 2• 7 R C: /� t O OWNER NAME f] LCL `1•.,(S KI PHONE "T�✓1 `"'1� (J��- M OWNERADDRESS 7+"�� CITY/STATFIZIP CONTRACTOR l �. ✓ L 2i PHONE cc, CONTRACTOR CONTRACTOR ADDRESS CITY/STATE/ZIPCAL G LICENSE ❑C-42 ❑C-36 OTHER :NUMBER EXPIRATION DATE � WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST I BUILDING PERMIT# AP—C(�U4'S 7.S LAND USE APPLICATION# TYPE OF WORK: .❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNEDIALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: Q17M.EICE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: P"*S'EPTICTANK TYPE/MFGCAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMEN/TSS� ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION 1 r\� ft PROPERTY LINE "1-\T ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) M-'� is LEACH LINES C3 LEACHING CHAMBERS #OF LINES -S LENGTH OF LINES 411 ft } I 'V DISTANCE TO NEAREST WELL S()1 ft FOUNDATION ((_)I ft PROPERTY LINE R ❑ FILTER BED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL_ ft FOUNDATION ft PROPERTY LINE ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft n ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft e DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft e ❑ DISPOSAL PONDS WIDTH it LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft �$EEPAGE PITS NUMBER WIDTH �(�( ft DEPTH 2�l ft l� DISTANCE TO NEAREST WELL V ft FOUNDATION d 1 ft PROPERTY LINE -L' 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 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED !- ,L.� TITLEDATE / I � j 91 t2 0 a 1 F.1131 ir A-E I e E r IN pL S _ DEPARTMENT USE ON Y Application Accepted Date 3U Uj Area Employee lD#_,57 __ Q� Final Inspection By Date l ❑ SPECIAL PERMIT-Approved by Character of Soil to p of 3 : mp Soil Character: COMMENTS 01.4 LoT of PE Sc Received ChecJdt/ Amount Permit/ Invoice# Permit I Code INFO 8 Cash Remitted Date Seevvice Request# IM Y2..1( 117 0(n 10"123 310 vJ 'Tier ''f'2-moi I S 42-02-001 ONSITE WASTEWATER PERMIT 12/27/2003