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tiOu'L/ <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN CGuutt ENVIRONMENTAL HEALTH DEPARTMew 1868 East Naziit°n AVOnU6-STOCKTON CA 05205-6232-(209)468-3420 <br /> NON.R EFUNDABLEPERMIT V, CALL 209 953.7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATEJSSUED <br /> JOBADDIFESS / AlesG LtA62r /Loop cITYIZIP tb f �h <br /> _� R S1,3'a-- I� <br /> CROSS STREET MAce�yd,LE /todq <br /> qpNPARCEL SIZE 1' <br /> _ oal-Oa0 4 Y <br /> 1 .3q S� b <br /> OOTIER HAVE SASo/ f(ICt4eer PHON' a'oR-32.7 -F3af/ <br /> OWNERADDRESS CRYISTATEMP <br /> CONTRACTOR. eov,rfzK V*ctFi/ 12:9 s£PTSG� V' <br /> !� ,�(4�HOYE ao4- <br /> CONTRACTORADDRESS 2314 Lir-SO64- <br /> CRY/STATEZP LOO.L <br /> LICENSE PC-42 00.36 OTHER NUMBER aO EXPIRATIONDATE <br /> WATERTAELE DEPTH: R GEOGRAPHICALINFORIAATIDN: Coordinates X V <br /> 0 PERCTEST # 13UILDINGPCRMITA' �.3_Qf_�(]_LAND USE APPLICATION# <br /> T'/PE OF WORK: NEW INSTALLATIOPI ❑ REPAIR/ADDITION 0 ENGINEER DESIGNED/ALTERNATIVE <br /> D ReFLACEH.CNT 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUiABER 07 LIVING UNITS: NUMBER OF13 ROOMS' NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPEIMFG_LO /11-j L CAPAfCAPACITY /PO/I gal nGp CCFPARIIdEN -_;2 <br /> _ <br /> ❑ GREASETRAP TYPE/MFG CAPACITY _ gal #OFCOMPARTMENTS <br /> DIETANCETONEAREST: WELL 260 -l- fl FoUNDAT1oN 3(e R PROPERTY Luna /aS� fl. <br /> ❑ LIFTSTATION 'SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OFLIN=5. LENGTH OF LINES YO R <br /> DISTANCE TO NEAREST WELL ,00 AY IT FOUNDATION R PROPERTYLINE�S� ft <br /> ❑ FILTEREED WMTR It LENGTH R DEPTH It <br /> DISTNNCETONEANEST itLL R FOUN'OATON R PROPERTYLLNE k <br /> (3 MOUNDED WIDTH R LENGTH ft DEPTH k <br /> DISTANOETONEAREST WELL R FOUNDATION R PROPERTYUNE R <br /> Ll sumps Wim R LENGTH. R DEFTN R <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE R ! <br /> ❑ DISPOSAL PONDS WiOrdR LENGTH it DEPTHR <br /> _ <br /> DISTANCETONEAREST^ 'WFULL R FOUNDATION_ft PROPERTYLINE R <br /> SEEPA.GEPITS Nu heft 2 VdwTx ft DEPTH I.r R <br /> DISTANCE TO NEAREST WELL ODS R FOUNDATION �OO� R PROPENTYUNE_ 10� R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK\NLL HE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTT ORDINM'CEB, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> rl NIMUf 4HOUR A7VANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(269)953-7697 <br /> SIGNEDz TITLEfa^-ff/AG7-o{L DATE <br /> O I <br /> N f <br /> L <br /> L N <br /> TT <br /> ' S <br /> if N 10 O JR1 C NTY <br /> NT <br /> DEPARTMENTUSE NLY <br /> Application Accept Date Lri 1 Area "\ R Empioyco$D# ejS kkc <br /> Final Inspection Date ❑ SPECIALPERMIT-Approvedby <br /> CharacteTof SoiltOD thof3Ft: PI Sump Soll Character•. <br /> COMMENTS e w L �- - o,t• �L <br /> PE SC Receivod Ch Amount pate P°rmiU Involce# Pe"It IDP <br /> Code <br /> INFO B ash Remitted Service Re uest# <br /> z l q .oJ 20o z <br /> 983 sg <br /> <2-01 ONSITE WASTEWATER TRTP.INT SYSTEM PEWIff <br /> twaroT <br />