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ONSITE WASTEWATE,�)REATMENT SYSTEM PERMIT <br /> '-SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT �- <br /> 304 E WEBER AVE-3"FL-STOCKTON CA 952009)468-3420 <br /> -7697 FOR INSPECTIONS NON-REFUNDABLE PERMIT CALL(209)953CTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> J i� j 5, LCA <br /> el <br /> fi 7 <br /> JOB ADDRESS ~i6 ( '-N.IG 'I u` �`� CITQY�l.Z1P I_IY-i 1 I `32_ m <br /> _CROSS STREET !'!A �L APN '1 -{ �1 PARCEL SIZE 7-11 <br /> y 4 A <br /> OWNER NAME G \ 1 r n 1 PHONE <br /> ff OWNER ADDRESS ".'$c YV -" CITYISTATE ZIP <br /> f (CONTRACTOR Iti �J �iE�i.Yt l !HCl r 1 ...S[iC i[? i .�, .. 1C., PHONE <br /> CONTRACTOR <br /> 'LICENSE 13C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> —WATER TABLE DEPTH: ft GEOGRAPHICALINFORMATION: Coordinates X Y <br /> ?ERC TEST # BUILDING PERMIT# LAND USE APPLICATION <br /> TYPE OF WORK: Ll NEW INSTALLATION LJREPAIRIADDITION LI ENGINEER DESIGNED(ALTERNATIVEC` <br /> ❑ REPLACEMENT ❑ DESTRUCTION - <br /> 'INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> N UMBER OF LIVING UNITS- NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> I �❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS C- <br /> 1; ❑ GREASE TRAP TYPE/M FO CAPACITY gal #OF COMPARTMENTS <br /> �❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE R <br /> `❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 'L—❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES R <br /> f� DISTANCE TO N EAREST WELL ft FOUNDATION ft PROPERTY LINE A <br /> �❑ FILTER BED WIDTH R LENGTH R DEPTH ft Com. <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE fl <br /> �—'❑ MOUNDED WIDTH ti LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> �❑ SUMP$ WIDTH fl LENGTH R DEPTH ft s <br /> ` DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> C-=❑ DISPOSAL PONDS WIDTH_ft LENGTH 11 DEPTH ft ..- <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> F❑ SEEPAGE PITS NUMBER WIDTH R DEPTH R <br /> _ DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE 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 REGULATION$OF SAN JOAQUIN COUNTY. <br /> yMINIM UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS--PLEASE CALL.(209)953-7697 <br /> SIGNED 1. i_JY1�_._ TITLE "7; t I DATE <br /> �3 T <br /> f <br /> D <br /> F111A I IODh <br /> f3 A AQ I c LINTY <br /> t vim AI_ <br /> ENT <br /> 11,I <br /> 3 <br /> I i <br /> 1 <br /> i <br /> E <br /> � v <br /> DEPARTMENT US'ON Y <br /> Application Accepted Byj �_S.t..c-.�v Dale ! �0�C'`� Area 1 i_ Employee IDN 5 S y <br /> 5 <br /> Final Inspection By Date 13 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Sail Character: <br /> COMMENTS <br /> F <br /> PE SC Received Checkft!.� AmountDate Permit) Invoice# Permit ID# <br /> Code INFO 6 es emitted Service Request# <br /> 14 10 11L? LAti�L�! <br /> s —42-02-00I <br /> ONSITE WASTEWATER PERMIT <br /> 17122/2003 <br />