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\ ONSITE WASTEWATER TREATMENT SYSTEM PERMIT /Odd SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3"D FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL. 209 953-7697 FOR INSPF.('TIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS / 6, / dp/ZrCL6MEn/T3 TZDAD CITY/ZIP L.ln/DEn( Ch 9.5 -32/ CROSS STREET �k/� 1€LF__�P�aD APN 0 -�3O�OS�QC PARCE.LSIZF. 12-0 A-e-- C �o SrN � •' __ 887—2 23 7 OWNER NAME: -/L �/E-/Y '�1/�,T /� P/ZONE ^ � OWNER ADDRESS NORTH CLE�I /7 KO�� CITE'/STATE%ZIP /—/NDE [ A Yr236 CONTRACTOR Ca NS /N PuoNE—"— -14C3 CONTRACTOR ADDRESS CITY/STATE/ZIP k R L.00 'FS-76'1— LICENSE S LICENSE ❑C-42 ❑C-36c OTHER NUMBER EXPIRATION DATE — WA 'RTABLEDEPTH: N/7J 1) GEOC:RAPHIC'ALINFORMATION: Coordinates X / PERC TEST # F3UILDING PERMIT# LAND USE APPLICATION / TYPE OF WORK: ❑ NEW INSTALLATION ❑ RF.PAiWADDITION ❑ ENGINEER DESIGNED/A LTE.RNATIVU ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS' NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS O ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ PKG TX PLANT DI.SEA.NCE:TO NEARE_SE: WELL It FOUNDATION ___ ft PROPERTY LINE ft ❑ LIFT STATION SIZE— TYPE OF PL MP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES fl DISTANCETO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH _It DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R ❑ SUMPS WIDTH ft LENGTH fl DEPTH fl DISTANCE TO NEAREST WELL D FOUNDATION fl PROPERTY LOAF ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE.TO NEAREST WELL ft FOUNDAI ION fl PROPERTY LINE (t ❑ SEEPAGE PITS NUMBER WIDTH H DEPTH ft DISTANCETO NEAREST WELL. fl FOUNDATION R PROPERTY LINE tl I HEREBSCE, lET'THAT I HA' PREPARED THIS APPLICATION AND THE WORK WTLL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY R INANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNT'. MINI. OUR AD%%NCH NOTICE REQVIRLD FOR INSPEC-TIONS-PLEASE:C'ALI,120414S3-7A97 SIGNED TITLE &A1^14fec DATE AO-I3-OS 3 05 UNN Ar I E P UI A TM .72 LY DEPARTMENT 11.)E ONLY '�y('J�(/p Application Accepted By Date Q Area -241 [mployce ICS- Final Inspection By Lel. �'i7 tG� Date ��/�Z.F/O� ❑ SPECIAL PERMIT-Approved by ,7/y Character of Soil to Depth of 3 Ft: PIUSump Soil Character: COMMENTS 46 to log � PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO B as Remitted Service R nest# �u1 D 42-02-001 ONSITE WASTEWATER PERMIT 12/22'2003