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4 <br />ON SITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 18680. HAZELTON AVENUE • STOCKTON CA 95205 -(209)468-3420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />Joe Arm 037 cpc4 Austin Road crryizip Ripon. 95366 <br />APN aS-7/ Ci D O PARCEL SIZE CROSS STREET E. Manama Road <br />cHN„EN NAME California State Parks PHONE 209-538-5930 <br /> <br />OWNER ADDRESS 22708 Broadway CrrviSTATEMP Columbia. Ca, 95310 <br />CONTRACTOR California Slate Parks PHONE 209-404-8541 <br /> <br />CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> <br />LICENSE I C-42 C C-36 OTHER <br /> <br />NUMBER EXPIRATION DATE <br /> <br />WATER TABLE DEPTH: <br /> <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />PERC TEST # <br /> <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIRTADOMON ENGINEER DESIGNED TALTERNATTYE <br />DESTRUCTION fe.v k REPLACEMENT .1)< Zwr!oveRancESEPTeSvorai <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />n RESIDENCE Ii COMMERCIAL <br />NUMBER OF BEDROOMS: <br />-I OTHER <br /> <br />NUMBER OF EMPLOYEES: <br /> <br />0 <br />0 <br />0 <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: <br />SIZE TYPE <br />WELL <br />OF PUMP <br />0 LEACH LINES LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL <br />CI FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />0 MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />0 DISPOSAL PONDS WIDTH II LENGTH <br />DISTANCE TO NEAREST WELL <br />SEEPAGE PITS NUMBER <br />DiSTANCE TO NEAREST WELL <br />SIGNED <br />MINIMUM 48 HOU - .:1:9INOTICE REQUIRED FOR INSPECTIONS - PLEASE CALI-009)953-7697 <br />TITLE p k osc-: kn.ivi..r. SvfosqllilrE- 2-/ 5-71-0 <br />DEPARTMENT,USE ONLY <br />Application Accepted Date 'POP / Area 5. /q q Employee 104 AS <br />Final inspection By Date '61 "S 2- -I SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pif/Sump Soil Character: <br />COMMENTS Resedel4 Ce he's FAIO-AIS MY! k. ivirk victs c 1 i,..i'ereof a Alci <br /><-,to ray,tor* <br />PE <br />Code <br />SC <br />INFO <br />Received CheckN <br />pash <br />Amount <br />Remitted Dat Permit/ <br />Service Request it Invoice II Permit MP <br />Lida I 07 <br />it/ Vi 'S1'--- 4 15-1) A 11 ill ,c1200g32(+1 <br />CAPACITY <br />CAPACITY <br />II FouNomiorg <br />gat <br />gal <br />ft <br />OF COAIPARTAIENTS <br />IT OF COMPARTMENTS <br />PROPERTY LINE <br />10 PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />It FOUNDATION <br />it OF LINES LENGTH OF LINES <br /> II PROPERTY LINE <br />Ii DEPTH <br />rt FOUNDATION II PROPERTY UNE <br />ft DEPTH <br />ft FOUNDATION ft PROPERTY UNE <br />ft DEPTH <br />fl FOUNDATION ft PROPERTY LINE <br />SA <br />ft DEPTH <br />ft FOUNDATION II PROPERTY LINE <br />ft FOUNDATION ft PROPERTY LINE fl <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />do7.)4 /2,o3/677 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14I113