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j ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT' 304 E WEBER Avc - 3N1 FL - STOCKTON CA 95202 - (209) 466-3420 <br />INON-REFUNDABLE PERMIT <br />❑ LEACHING CHAMBERS <br />CALL(209)953-7697 FOR INSPECTIONS <br />EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS _ <br />_ LENGTH of LINES ft <br />' l,rT CIT m, <br />r ' 1 <br />CROSSSINLET M ' <br />U Z <br />APN 21 �.Z-V <br />J-1 <br />Q�� �qp <br />�� PARCELSME _ <br />O1tiNER NAMF,&RD <br />U FILTER BED <br />, /l <br />PHONE <br />OWNER ADDRESS 6(1)) I—+'j_� <br />Ck ,il`-T ({(�J CITY!SfATE/ZAP <br />DEPTH ft <br />CONTRACTOR fG.C_L. IL <br />L?( -1 <br />un, P- <br />WELL. <br />PPuONE <br />CONTRACTOR ADDRESS �C1� <br />L -C1 <br />�]�'rA}, <br />�r C�� CITYIS!'ATEJZ,Ip <br />[ n <br />LICENSE ❑ C-42 ❑ C-36 OTHER <br />NUMBEREXpIRATIUN' <br />DATE <br />WATER I -ABLE DEPTH:_ _ ft GEOGRAPHICALINFORMATION: COnrdiRatea X Y _ <br />❑ PERC TEST (s) ,UMBER LAND USEAPPLIC'ATION # <br />TYPE OF WORK: ❑ NEWINSTALLATION REYAIRIABUF'FifiN' Ste" �KCGt/E,Q_�, <br />D. IGNEWALTERNAT'IVE <br />❑ REPLACEMENT ❑ DESTRUCTION ) <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER_ _ <br />NUMBER OF LIVING UNITS: _ \UMBEROFBEDRoomS: NUMBEROFEMPLOYQES: <br />❑ SEPTIC TANK fvrF MFG ESI 1 : f t N C7' ( O 1C�7- CAPAC171'gal OFC:OMPARTMFNTS_ <br />❑ GREASE TRAP TSRE/MFG CAPACITY gal fi OF COMPARTMENIS <br />❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION P. PROPERTY LINE fl <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />❑ LEACHING CHAMBERS <br />n OF LrNES <br />_ LENGTH of LINES ft <br />DISTANCE TO NEAREST <br />WELL <br />fI FOUNDATION <br />—11 <br />PROPERTY LINE ft <br />U FILTER BED <br />Wttnx_.................. _...... ............ <br />._ ft <br />LENGE <br />r1 <br />DEPTH ft <br />DISTANCE 10 NEAREST <br />WELL. <br />ft FOUNDATION <br />ft PROPERTY UNE }} <br />❑ MOUNDED <br />WIDTH <br />ft <br />LEN$IH <br />_ ft <br />DEPim ft <br />DISTANCETONCAREST <br />WELL— <br />ft FOUNDATION_ <br />R PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH ................................................. <br />A <br />LENorti _ <br />4t <br />DEPTH ft <br />DISTA mmNEAwr <br />WELL <br />_ft FOUNDATION <br />R PROPERTY LINE 11 <br />❑ DISPOSAL PONDS WIDTH _—____-- <br />R <br />LENGTH _ <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCETONF.ARFSf <br />WC•IA <br />ft FWNDA'r1ON <br />ft PROPER'T'Y LINE ft <br />1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORT: WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGI II.ATK)NS OF SAN JOAQUIN COUNTY. <br />11 <br />G <br />,,/j YGfAR11AG1� V•k-V11Li <br />Application Accepted by -1•,�J Date � r Arra c�-� � Employee 1Dq 1�'S� <br />Final Inspection By _ _ _ Date t L El SPECIAL PERMIT -Approved by <br />Character of Soil ro th ai 3 Ft: PWSump Soil Character. <br />COMMENTS [/cce n.r �— o f fiAc..+d e:. u.�•�€e isP – C3 e��FlaC�o .ot�xc�c�re,: ne.Dfzte <br />el ores not r. C°eor4c.--1g -k- c.(�Gc <br />'-,+-n.,,.t� Go.,•a....�__ d „-G.. �_ /.e o -1.L_ !. r.� !r 1 ._ _.[ �`�% r� _� .. ..�' , _ .,o .,.1, ,_ / l �.b / ✓ ��.. e _ _ �- Y_ „/!_ �r.� <br />PIE St: Received Amount rmiU . <br />Code IN B Cash mitted Datc -vice Re Vest q Invoice tl Permit IDit <br />�3_. f o 11 •'SA. _ �- I"F-"v �I ,�j3(ob <br />ie <br />Ib2r02 ONSITE EWATERPERMIT <br />