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04 07 09:39a Double B Demo 916 9830701 p.3 <br />t- <br />` ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E. Main Street- STOCKTON CA 95202 - (209) 466.3420 <br />NON-REFUNDABLE PERMIT .ALL (2(19) 9j3-769? 1 O INSPECTIONS EXPIRES I YEAR FROM DATE ISSUEI <br />JoBADDRESS <br />CROSS STREET L. r <br />( � R(% AW (iE Pel -00 APN O 9!�4 — 0 O- O 2- PARCEL SIZE ©• 2-3 <br />OWNER NAME SToU�an.1 ]ah,- M i 16' Q, ye;Qz <br />OWNER ADDRESS j CITV/STATE/ZIP <br />CONTMCIOR D&MO fl oA) PHONE <br />a <br />0 <br />LICENSE U C-42 <br />LJ C-36 OTHER <br />NUMDER EXPIRATION DATE <br />WATER TABLE DEM. <br />If GEOCRAPIHCALINFORMATION: Coordinates X Y <br />❑ <br />PERC TEST k <br />1 BUILDING PERNHT # <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />❑ NEW INSTALLATION O <br />REPAWADDmON O ENOINEERDESIGNED/ALTERNArFVE <br />❑ REPLACEMENT <br />SK DESTRUCEION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE <br />❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: N UMBER OF BEDROOMS: NVMUEROFE VERS: <br />❑ <br />SEPTIC TANK <br />TYPE,,MFG <br />CAPACITY I G C AR I NfhNTS <br />❑ <br />GREASE TRAP <br />TYPE/MFG <br />CAPACITY10nRI&I.N J,FCUMI ARTND- S <br />❑ <br />PKG TY PLANT <br />DISTANCETO NEAREST: WELL <br />R FIYJNUAHUN 1 <br />it <br />O <br />LIFTSTATIOV <br />SIZE TYPEOFPUMP <br />A T NCLOSED SYSTEM) <br />a <br />13 <br />LEACH LINES <br />❑ LEACHING CHAMBERS <br />S OF LiNb's LENGTH OF LINTS <br />fl OD <br />DISTANCE TO NEAREST WELL <br />R FOUNDATION ft PROPERTYLINE <br />ft <br />❑ <br />FILTER BED <br />WIDTH — ft LENGTH <br />ft Durni <br />fi (� <br />DISTANCE TO NEAREST W1iLL <br />It FOLDIUATION fl PROPOtTYIJNE <br />fl <br />❑ <br />MOUNDED <br />WIDTH fl LHNOTII <br />R DI:PnI <br />ft <br />DISTANCE TO NEAREST WL -LL <br />ft FOUNDATION ft PROPERTY LINE. <br />it <br />❑ <br />SUMPS <br />WIDTH ft LIiNG111 <br />ft DLPDI <br />ft <br />DISTANCE To NEAREST WELL <br />ft FOUNDATION Il PROPERTY LINE _fl <br />❑ <br />DISPOSAL PONDS WIDTH it LENG'DI <br />ft DHPn'I <br />O <br />DISTANCE TO NEAREST WELL _ <br />R FOUNDATION It PR()PER'fY LINIi <br />R S <br />O <br />SEEPAGE PITS <br />NL.m= WEDTR <br />It DEPTH <br />R <br />DISTANCE TONEAREST W1iL1. <br />It FOITKDA7-0N ft I'A0PERIYLINIi <br />fl <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORDINANCES. STATE LAW'S AND RULES <br />AND REGULATIONS OF SAN JOAQUIN COUNT'. <br />h <br />//{�1\ <br />IU \1:4k1OUR,IDVANCI•NO'1'I('HRF:QUIREDF(IHINSPE(T(O'S <br />1..tiAbEC•t1.LUCi`I)`li3 X0++1% Q <br />V <br />SIGNED le <br />1 z .G/ VGA+W` <br />TITLE <br />DATET <br />77 <br />r n <br />R udl M <br />o?s' M4 Win. <br />42,02-001 .b /() ` . 1 ��i'�, O` o i� s3� A D <br />Iz22n003 <br />- <br />PE SC Received CherkM/ Amount UF'PA R'f.V1iN�l'II�),i E`yN�LA <br />Application Accepted By Dat c Arca Employee IDM <br />Final Inspection By Date ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of3 Ft: Pidsump Soil Character. <br />COMMENTS <br />C-0 Do -3 5' q '1 Ci <br />Date PePermit/levoicc I <br />Code INFOCash Remitted Sal -ice <br />- <br />PE SC Received CherkM/ Amount UF'PA R'f.V1iN�l'II�),i E`yN�LA <br />Application Accepted By Dat c Arca Employee IDM <br />Final Inspection By Date ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of3 Ft: Pidsump Soil Character. <br />COMMENTS <br />C-0 Do -3 5' q '1 Ci <br />Date PePermit/levoicc I <br />Code INFOCash Remitted Sal -ice <br />