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, �f & ONSITE WASTEWATER T_kATMENT SYSTEM PERMIT <br />�ANJOAQUIN COUNTY ENVIRONMENTAL.HEALITI DEPARTMENT <br /> 304 E WEBER AVE-3FL-STOCKTON CA 4.5202` )468-3420 <br /> NON-RFFUNDARLE PERMtT CALL{2091 _ -'1697 FOR INSPECTION',' EXPIRES I YEAR FROM. .E ISSUED H <br /> +9 a <br /> n tl��, U <br /> Y2 r1, - CLT\YELP <br /> JD9ADDRESS � �} ,f1 �� � <br /> APNaI3'kJBU•_` 2 �,L. 2� PAR(TI.SI7.E.533.�3 10 <br /> CROSS STREET <br /> PHONE Z ! a <br /> OWNER NAME <br /> S bve—S r Ag 9k �11j��- COT <br /> Y1SrATe1ZIP — <br /> OWNER ADDRESS O <br /> III <br /> r I . PHONECONTRACTOR C- CITYlSTATElIIP <br /> CONTRACTOR ADDRESS I <br /> NUMBER EXPIRATION DATE. <br /> LICENSE ❑C-42 ❑C-36 OTHERY - <br /> WATER TABLE DEPTII: /--�^ 11 GF.OGRAPHICALINFORMATION: COCITdinatek X <br /> LAND USE APPLICAT1ON# <br /> PERC TEST(S) NUMOER <br /> EP <br /> ❑ REPAIR/ADDITION <br /> RIADDITION ❑ ENGINEER DESLGNED/ALTERNATIVE <br /> TYPE OF WORK: ❑ RINSTALLATION ❑ DESTRUCTION l M <br /> (] REPLACEMENT <br /> ENT <br /> ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER I <br /> [INSTALLATION WILL SERVE: NUMBER OF EMPLOVEF:S: v, <br /> NUMnER OF LIVING UNITS: NUM BF.R OF BEDROOMS: <br /> CAPACITY Sal #Of'COMPARTMENTS <br /> ❑ SEPTIC TANK TYPFJM FG II #OI'COMPARTMF.N'IS <br /> ❑ CREASE TRAP TYPFIMFG CAPACITY 8 <br /> 1I1 paopI;R'I v LINE. 11 <br /> C1 I'KG TX PLANT DISTANCE10 NEAREST: WELT, li I+HUNunrulN <br /> (_j 1 IFI STATION SIXE TvI'k:Or Pum 11 ❑ SAND 011,SEPARATOR(VNCLOSEI)SYS'T'EM) <br /> OF f1 <br /> CI LEACH LINES 13 LEACHING CHAMBERS LINES LENGTH OF LINES 4 <br /> R FOUNDATION R PROPERTY LINE <br /> D15rANCETO NEAREST WELL R <br /> WIDI11 R LI:NGIII Il DI'.PTIi <br /> ❑ FILTER I1eb n } <br /> Il t-O]INIIA-I'E+N I} I'R+SI'I'.I(I-Y I,INl!��-__ <br /> UksrnNrl:'eONE:nIIL;yI' whls. '-- it <br /> —..._.—. --- - <br /> _ tl I.>''.NI II I I _ R 111:1'I I I - .._------ __..__.—_..�-- <br /> ❑ h111llNlli•:II Wn1r11 -._. _.._____..-_... .. ._.. It <br /> Il I'M IN nAIII IN Il I'Il1I FaIY1.INT,_____- <br /> 1115'1'ANf:E:'1'11NE.AHI':ti1' WI:I,I.___,�_-�-.__. �--- -"---'-"'-' R <br /> f1 LENGIII 11 I)k[I'IT <br /> ❑ SUMPS WIUl'll Il PROPERTY LINE f1 <br /> D1sIANCE TO NEAREST WELL R FOUNDATION <br />` R LENGTH f1 DEPTI% 11 <br /> I Ll DISPOSAL PONDS WIDTH R <br /> 11 FOUNDATION F1 PROPERTY LINE <br /> . DISTANCE TO NEAREST WELL. R DEPTH R <br /> U SEEPAGE PITS WIDTH R LENGTH Il rnONsary LINE f? <br /> DISTANCE.TO NEAREST WELL R FOUNDATION <br /> 1 HEREHY CERTIFY THAI'I HAVE PREPARED THIS APPLICATION AND TIIE WORK WILL ISE DONE:IN ACCORDANCE.WITH SAN JOAQEIN COUNT-)'ORDIT}IANCKS, <br /> STATE:LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUN"1'1'. <br /> 1 24 HOUR ADVANCE NOTICE:REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> TITLE, 4)4e// -IZ DATE. <br /> SIGNED ~ <br /> l � <br /> 1 <br /> 5 <br /> y <br /> 7D 3 <br /> s <br /> DF.PARTAIENT 11'' ONL r— r <br /> Appllcalinn Accepted Ily <br /> Unlc_,_-�, 8mployee IUH cj�_j� <br /> iFinal Inspu(I n 13y �, ;.,� _ Dulc� ❑ tiPEC1AL PES-R.rh.11T-Approvveed�pb�yy <br /> li PitlSunlp Soil Chnracl�'�`S tL•-^�' <br /> Clio racterofSol{t0 ptha I: 0 IQvA L 41�A <br /> COMMENTS ' 4 0��c <br /> T <br /> pF SC RerelvrJ Check At a.;ml Permlll Invoice D Perndl U10 <br /> Dole Service 12c/urst Il <br /> COdr INTO It .aeh RrmII1rA <br /> Jen () <br /> 42-01-001 'S d / ?4, ­ciTt.-++'AcTr1YATTo 11:149T <br />