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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE - 3Me FL- STOCKTON CA 95202 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CA�W209) 953-7697 FOR INyfEl T10NS _ E.XPIUS 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS .' / L�(�,//.,f ��� Aee-lf CITY/ZIP /—j - J RSayZ <br />CROSS STREET >S sLi fL/O.KJI/4GCJ APN ��j-toQ - I q PARCEL SIMS <br />OWNER NAME i7 (/a D(�„��B'�(� PHONE <br />OWNER ADDRESS o -5,-) <br />A xr ✓ \ T CITY/STATPAZIP <br />/,/AAs/^/ <br />CONTRACTOR /Y /r - l -r,- cS. � "J . L �Y Ci --- <br />ADDRESS <br />. - - <br />ADDRESS <br />L LICENSE AC -42 ❑ C-36 OTHER NUMBER EXPIRATION DATE <br />i ) �r� <br />WATER TABLE DEPTH: 4;zo ft GEOGRAPHICAL INFORMATION: Coordinates X V <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # . <br />TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />❑ REPLACEMENT ❑ DESTRUCTION <br />INSTALL ATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBEROF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br />❑ SEPTICTANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />❑ GREASE TRAP TYPEIMFG CAPACITY gal # OF COMPARTMENTS <br />❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE R <br />❑ LIFT STATION Size TYPE OF PUMP ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />y <br />D <br />v <br />r <br />I <br />�1 <br />Application Accepted B J D to _I L' "1'�5 Are. Employee ID#-/ <br />Final Inspection By. ate �� ❑ SPECIAL PERMIT - Approved by <br />Chaeactee of FII to Denlh I7 Fn Db1C....... G!I 1--- <br />42-02-001 ONSITE WASTEWATER PERMIT , <br />12/22'2003 <br />3 <br />❑ LEACH LINES <br />�K LEACHING CHAMBERS <br />:74 <br /># OF <br />LINES <br />LENGTH OF LINES <br />DISTANCE TO ,NEAREST <br />WELL <br />h FOUNDATION 10 <br />ft PROPERTY <br />LINE <br />��ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH I00 <br />Min <br />R <br />DEPTH <br />fl <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY <br />LINE <br />ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY <br />LINE <br />ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />R <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />R PROPERTY <br />LINE <br />ft <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />R <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY <br />LINE <br />ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELT.. _ <br />ft FOUNDATION <br />R PROPERTY <br />LINE <br />ft <br />y <br />D <br />v <br />r <br />I <br />�1 <br />Application Accepted B J D to _I L' "1'�5 Are. Employee ID#-/ <br />Final Inspection By. ate �� ❑ SPECIAL PERMIT - Approved by <br />Chaeactee of FII to Denlh I7 Fn Db1C....... G!I 1--- <br />42-02-001 ONSITE WASTEWATER PERMIT , <br />12/22'2003 <br />