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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS ^ LXPIRES I YEAR FROM LATE 1SSU1 <br />JOB ADDRESS ZoLtS 6 N ~W'f 010) CITVIZIP GpMPID <br />CROSS STREET W O00%A%Q ,E RopA APIN PARCEL SIZE. `+ Z S <br />OWNER NAME PliLEX A«o% PHONE 6�3-$SSS <br />OWNERADDRESS r)"r' !XS A03g%f G- CITY/STATE/ZIP <br />CONTRACTOR W25I c.oASi %AcKNOE INC. PHONE 2$7°1 <br />CONTRACTOR ADDRESS %\b` 9%0164 QCIN'1 O1, CITY/STATE/ZIP LO�2 G^ o1SZ`IJ <br />' <br />LICENSE 13C-42 13C-36 OTHER , A tl -- NUMBER V S \t s, F,XPIRATION DATE O <br />WATER TABLE DEPTH: ft GEOGRAPHICALINFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # — 07 0009 k LAND USE APPLICATION # <br />TYPE OF WORK: NEWINSTALLATION 13 REPAIR/ADDEr1ON ❑ ENGINEER DESIGNED /ALTERNATIVE <br />❑ REPLACEMENT ❑ DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 1:21 NUMBER OF EMPLOYEES: <br />3 SEPTICTANK TYPE/MFG � <br />❑ GREASE TRAP TYPE/MFG- <br />DISTANCE TO NEAREST: WELL ft <br />❑ LIFT STATION SIZE TYPE OF Pump <br />CAPACITY 1600 gal # OF COMPARTMENTS iL <br />CAPACITY Bal # OF COMPARTMENTS <br />FOUNDATION ft PROPERTY LINE ft <br />❑ PKGTXPLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0LEACH LINES ❑ LEACHING CHAMBERS # OF LtNEs LENGTH OF LINES 40 1 ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION fl: PROPERTY LINE R <br />❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LME ft <br />❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ SUMPS WmTH ft LENGTH ft DEPTH R <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WnrrB ft LENGTH ft DEPTH ft <br />DISTANCETONEAREST WELL ft FOUNDATION It PROPERTY %LINE ft <br />tl J SEEPAGE PITS NUMBER W"M 3 b,i rr ft DEPTH TS ft <br />DISTANCE TO NEAREST WELL Lavnft FOUNDATION D� ft PROPERTY LINE <br />I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MININIUM24HOUR ADVANCE N UIREDFOR INSPECTIONS— PLEASE CALL .(209)953-7697 <br />SIC •rr�•rr. nrFL./YL'�. r/) DATE �-7-1-3)l <br />O. abs <br />yb• <br />tj <br />Drain [xis <br />woo 4' <br />d1 ��. i• <br />Paved' • / <br />Par <br />Dril;eway /�� arang <br />ExistIng Gravel 0 lay <br />r' <br />I <br />— <br />n <br />i [x sting i I. <br />, I <br />L' house - -- I <br />q p,.+ <br />Q1 NOTE: <br />r...J <br />Grade Sake ko drmrt away <br />from bldg. -- 5% To, 10'. <br />DEPARTMENT USE ONLY s 3(n(p T <br />Applicatlou Am Date 12-110 -7 Area Employee ID# �9 <br />Final [napectio D. 5���� [3SPECIAL PERMIT - Approved b}k <br />Character of Soil to Depth3 Ft: Pit/Sump Soil Character: <br />COMMENTS M E� �i o f Tt<F CO P D Y T m o /� G <br />it <br />PE SC Received heck# Amount Date PerodU Invoice # Permit ID# <br />Code INFO B Cash Remitted Service Ftequest# <br />42-(r It am 3/ 1fSn.t7J <br />c yt y� <br />CLP ��/? c/p c�tsv, o' /22Trfi.'y �r��rr�iY TJ i+s7vi' ONSITASTEWATLKItMIT' "' <br />