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ONSITE WASTEWATER TREATM 'SYSTEM PERMIT SAN JOAQUIN CC .ENVIRONMENTAL HEALTH DEPARTMENT E WEBER AVE-3M0 FL-STOCKTON CA 95202 -(209)46$-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED JOB ADDRESS -Z(0-139 E• M')l e i Ave-e- CITv/ZIP E I C g I D-i I g 5 3 2 0 W L u CROSS STREET E S r a l D-� b e-O o f q APN Z-L 1-o H 0 -o 3 0 PARCEL SIZE 9 4 q C"e.S c pp � O OWNER NAME Ve./�4P--, lPrope,-4-- eS I'LL PHONE r- � OWNER ADDRESS SIS Lye,I I - I 0 1 CITY/STATE/ZIP M o des i-o r-4 `1 5 3S t, CONTRACTOR trr o v-cl -O h u PHONE 3 £SFS 9 \` CONTRACTOR ADDRESS (1 ) .,'- 4,r-e- CITY/STATE/ZIP FS Cu I P-h O LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEETH: 5 to Fee+ ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADD ❑ ENGINEER DESIGNED/ALTERNATIVE 13K REPLACEMENT ^ RUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: t A SEPTIC TANK TYPE/MFG Pre.-cu s+- 1 P 5 L CAPACITY I Z 0 D gal #OF COMPARTMENTS Z ❑ GREASE TRAP TYPFJMFG CAPACITY gal #OF COMPARTMENTS PKG TX PLANT DISTANCE TO NEAREST: WELL ZOO R FOUNDATION O ft PROPERTY LME g G—�ft r ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) \� C LEACH LINES ❑ LEACHING CHAMBERS #OF LMES Z LENGTH OF LINES to U ft DISTANCE TO NEAREST WELL Z o6 R FOUNDATION R PROPERTY LINE F 00 ft ❑ FILTER BED WIDTH 10 R LENGTH `L O ft DEPTH /0 ft DISTANCE TO NEAREST WELL Z S O ft FOUNDATION y 0 ft PROPERTY LINE 900 ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH fl n DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LME ft �\ ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL_ft FOUNDATION R PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WmTH ft DEPTH it \ DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDS NC AS ALE AND f',ND REGULATIONS F SAN JOAQUIN COUNTY. T ` Com:�.ATE, Wa...� MINIMUM 24`H�OUR_A VA CE NOTICE REQUIRE FOR INSPECTIONS1-PLEASE CALL(209)953-7697 05 +Pr'��/0 TITLE �'�T O `R- DATE tf— DEPARTMENT U E L Application Accepted B EmplD}ec 1fNF Final Inspection By _ PI oy- d by Character of Soil to Depth o Ft: 'hit/C..Soil Character. COMMENTS l PE SC Received Check#/ Amount to Permit/ # Code INFO v Cash Remitted Service Re uest# rit r— mtvv 2 0 42-02.001 ONSITE WASTEWATER PERMIT 12/22/2003