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ONSITE 'v.ASTEWATER TREATMENT SYSTEM r RMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3Y°FL-STOCKTON CA 95202 -(209)468-3420 NON-REFUNDABLE PERMIT CA—IL 209 953-7(197 FOR I%SPECTIO%S EXPIRFS I VELAR FROM DATE ISSUED JOBADDRESS � �•� 'ITV/"LIP / 5l y -�y- CRUSS STRF.F.T APN PARCELSIZE D n �J O OWNER NAMF. •./ fi 2 Z PHONE 4=J 9/-7 Q.1-e '1 OWNER ADDRESS �Tr'"/ '\J CITY/STATFJZIP CONTRACTOR / • y � PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE -42 ❑C-36 OTHER NUMBERrr- EXPIRATION DATE f WATER TABLE DEPTH: ft GEOGRAPHICAL.INFORMATION: Coordinates X V J ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: 2UESIDENCE ❑ COMMERCIAL. ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDR MS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG�b/LL/Li•`b' 15k;,"A74 CAPACITY ipg'19 gal #OF COMPARTMENTS_ 1 ❑ GREASE TRAP TYPE/MFG CAPACITY /'� gal #OF COMPARTMENTS 13 PKC TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION �L ' R PROPERTY LINE R \ ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) n LEACH LINES ❑ LEACHING CHAMBERS #OF LINES_0 LENGTH OF LINES R DISTANCF.TO NEAREST WELL ©O ft FOUNDATION ��ft PROPERTY LINE 142 it O FILTER BED WIDTH ft LENGTH ft DEPTH R DISTANCE.TO NEAREST WELL R FOUNDATION it PROPERTY LINE. ft ❑ MOUNDED WIDTH ft LENGTH it DEPTH ft DISTANCF.TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R ❑ SUMPS WIDTH ft LENGTH Ii DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE.TO NEA REST WELL ^�R FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBERWIDTH — i.!5-- ft DEPTH C� ft DISTANCE TO NEAREST WELL—_Z4� �ft FOUNDATION R PROPERTY LINE !� R 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. T M1� 1UA)21/,HOUR ADVANCE VO'I'I EREQUIRE[ FORINSPECTIf S-PLF.ASF.CALIA209)953-7697 SIGNED 5�=%� SD407T^3. C-L='I.l� DATEX" CAI xf Al Zz AV Lir A0 JA^11 1 U S� A L / i 016.ry 77 -DEPARTS 'T U ON.Y -- Application Accepted Date 1 Area Employee ID# -f Final Inspection B Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Dep 3 Ft: Pit/Sump Soil Character: COMMENTS i <; /.c /`<"L s•�G•7�r - G'l 7�- �/ •l/. u�/f�7iv'Ste! !' IS 'Gam' c ' 6 5c�'7r CA 1 �!� f PE SC Received Check#-- Amount Permit! Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# K o CG- 42.02.001 ONSITE WASTEWATER PERMIT 12222003