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r�1 <br />14,5- �-y <br />1 P ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE - 3Pe FL - STOCKTON CA 95202 - (209)461.3420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />Joe ADDRESS -,D Li r) 4y CITY/7d► f c K }afl I L 1f 55,�� I S <br />CROSS STREET r) r, Saf) APN 18 '02033 PLA/RCELSI7-E7 / <br />OWNER NAME IC O M1 1 � PHONE 1 b L1 —J 7 5t+ <br />OWNER ADDRESS <br />CITY/STAT'FJZIP <br />I CONTRACTOR <br />S lh G: LIC 9s -3G --Z4 V, CL- PHONE K.S L- 9t2g.S <br />CONTRACTOR ADDRESS <br />"- CITY/S`FATF/ZIP <br />LICENSE ❑ C-42 <br />O C-36 OTHER _LO-_ NUMBER�n1�S .SAY EXPIRATION DATE <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST #� <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: <br />W NEW 1NSTALLATIoN ❑ REPAIR/ADDITION 0 ENGINEER DESIGNED /ALTERNATIVE <br />❑ REPLACEMENT ❑ DE.STRucTioN <br />INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBeRoF LIVING: UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />�/ <br />LI SEPTIC TANK <br />TYPE/MFG— eo L-. ____--- CAPACITY 2'ti� gal MOF COMPARTMENTS_ <br />❑ GREASE TRAP <br />TYPFJMFO CAPACITY gall M OF COMPARTMENTS <br />❑ PKC TX PLANT <br />DISTANCETO NEAREST: WELL d j It FOUNDATION ICI t R PROPERTY LINE 70 t R <br />❑ LIFT STATION <br />SIzE TYPE OF PUMP ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />❑ LEACHING CHAMBERS M OF LINES 3 LENGTH OF LINES 46 ft <br />DISTANCE TO NEAREST WELL I C5 ft FOUNDATION 10 1 ft PROPERTY LINE I'N / R <br />❑ FILTER BED <br />WIDTH ft LENc;m ft DFPnj fl <br />DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH fl LENGTH _ R DEPTH ft <br />DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br />❑ SUM11P5 <br />WIDTH R LENGTH fl DEPTH R <br />DISTANCE To NEAREST WELL ft FOUNDATION _ ft PROPERTY LINE <br />❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH <br />DISTANCETO NEAREST WELL R FOUNDATION }! PROPERTY LINE fl <br />V SEEPAGE PITS <br />NUMBER mrH L R DErM Is/11 <br />DISTANCE TO NEAREST WELL 1 11 FOUNDAVON f ft PROPERTY LINE __tt71 ft <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 />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECI"IONS - PLEASE CALL (2091 953-7697 <br />SIGNED I,(✓L.. <br />TITLE Gn+'L f-%a�f�/-' DATE <br />3 <br />n <br />v <br />DEPARTMENT U. ONLY <br />Application Accepted B - _ Date Arca w�l Employee IDN -y�9 <br />Final Inspection B( I� _ Date _ / __�/ A� O SPECIAL PERMIT -Approved by <br />Character of Soil to ep of 3 Ft: _ Pit/Sump Soil Chancier. <br />COMMENTS /: <br />l�J� /%a.' <br />PE SCReceived Cha- Asnaeslt Permit/ <br />Code INFO B 'ssh Rasuluad Date Service R uest N Invoke Y Permit IDM <br />0 '1 0 <br />