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ONSITE WASTEWATERTREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEAL'i n DEPARTMENT 104 E WEaER AVE - 3' PL- STOCKTON CA 95202 - (209) 468-3420 NIIN-REFUNDABLE PERMITsC p A CALL (ZU9) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 4�/Q��y{(,/, 1l'��F-'E�aP-S _ ']CITY//'Z�II' CROSS STREET LT I`CMa'n�-�'�"bl �+n��"AYI PARCEL. SIZE ,__tl:2� 1�5 OwNERNAnaE Viivgf� 7� l.f�Bl'� LetzQ PHONE OWNERADDRESS �! `IT�J' (51 ✓2�ZS;;- CITY/STATE/ZIP CONTRACTOR _.� )gof`-- c-beP4�Yl-f�"� A�3/F ��L)4..Y1��. t��t i1 PI[ONF.�ILy)-�nd J[��r1n__ CONTRACTOR ADDRESS 15� 1 0, 1[��S]1'�+�AQN'e NO - _ CITY/St'ATt%ZIP � V 3 �. _`� W _ LICENSE 91-C42 ❑C-36 OTHER EXPIRATION WATER TABLE DEPTR;_ ft GEOGRAPHICALINPORMATION: COOrdlitatel X V '% LEACHING CHAMBERS 5'f1w-?-q N OF LINES I _ I _ PERC TEST (%) NUMDFR _ LAND USE APPLICATION N T I WEI'.I. ��t.R FOUNDATION }E7 _ft TYPE OR WORK: ❑ NEW INSTALLATION ❑ FILTER BED REPAIR/ADOITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT _ ❑ DESTRUCTION DISTANCE TO NEAREST` INSTALLATION WILL SERVE: ® RFsinENCE ft PROPERTY LING ft ❑ COMMERCIAL ❑ OTHER WIDTH NUMBER 09 LIVING UN ITS: _ +� NtIMBEROF BEDROOMS: NUMBER OF EMPLOYEES: JiL SEPTIC TANK TYPE/MFG eftlN� '- -P,* r7J CAPACITY 0 gal 4 OF COMPARTMENTS +�7 L- ❑ GRFASETRAP TYPE)MFG _ ft LENGTH _ R ` CAPACITY gel 110E COMPARTMENTS ❑ PKGTXPLANT DISTANCETONEARF.ST: WELL WELL ft FOUNDATION ft ft FOUNDATION f: PROPERTY LINE. ��r Il ❑ LIFT STATION SIZE TYPEOP PUMP ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES '% LEACHING CHAMBERS 5'f1w-?-q N OF LINES I _ LENGTH OF LINES. L40 f fl DISTANCE TO NEAREST T I WEI'.I. ��t.R FOUNDATION }E7 _ft PROPERTY LME ❑ FILTER BED WIDTH _ _ _ ft LENGTH _ _ _ _ R DEPTII A DISTANCE TO NEAREST` WELL R FOUNDATION ft PROPERTY LING ft ❑ MOUNDED WIDTH ft LENGTH fl DEPTH 11 DISTANCE TO NEAREST WELL ____D FOUNDATION_ ft PROPERTY LINE ft ❑ SUMPS WLDni _ ft LENGTH _ R ` DEPTII 11 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl ❑ DISPOSAL PONDS WIDTH ft LENGTH _ R DEPTH ft DISTANCE TO NEAREST WELL FOUNDATION ft PROPERTY LINE R 3 SEEPAGE PITS WIDTH !! `_ _ft t I&Fx 5 1t DEPTH '�-�J�- ti DISTANCE TO NEAREST WELL 100 r� R FOUNDATION ICJ 7 ft PROPERTY LINE 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. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953.7697 SIGNED --, �' _ 'TITLE l DATEi� Date_ _ /ef -d❑ SPECIAL PERMIT - Approved by Pit/Sump Sail Charatler: .2.01.001 12/2/02 ONSITE WASTEWKI"ER PERMIT I Ad