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ONSITE WAS -. = <br /> WATER TREATMENT S �VNWV` <br /> PERM T 00.2?a1c;P <br /> SAN JUNTY ENVIRONMENTAL HEALTH lixrPARTMENT 304 E WEBER*-+E -3"°FL-STOCKTON CA 952(12 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FR�Om DATE ISSUED <br /> JOB ADDRESS ALL�� P 71 <br /> CITYIZIP /`t[�� �q�(�� <br /> CROSS STREET '-'�- ¢` APN 4049:7 -a+0[r " l7_ PARCEL SIZE q p <br /> OWNER NAME L`'` �� �"4'GL��� - PHONE <br /> OWNER ADDRESS /� G�44I 1 l�� CITY/STATE/ZIP 22=`? <br /> CONTRACTOR / ! /� ca PHONE J v <br /> 41 P1 4 <br /> CONTRACTOR ADDRESS - CITYISTATFJZIP ® �J \WW,,,3�♦♦♦ ' <br /> LICENSE C 42 ❑C-36 OTHER NUMBER EXPIRATION DATE rV <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> i <br /> i <br /> ❑ PERC TEST # BUILDING PERMIT# XfKkLAND USE APPLICATION# <br /> I <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF L1 V1 NG UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: rJJJ`�� <br /> NI <br /> SEPTIC TANK TYPEIMFG Al /yKsII,,-,— ���ez--/-- CAPACITYYAM <br /> gal #OFGOMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gai #OF COMPARTMENTS Of <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION a� _ ft PROPERTY LINE j4roo ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> i <br /> LEACH LINES &+LEACHING CHAMBERS #OF LINES �' LENGTH OF LINES ft <br />' DISTANCE TO NEAREST WELL.....�� ft FOUNOATIONft PROPERTY LINE S-Z71 ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE' ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH + ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEARES !�/►WELL ft FOUNDA fI PROPERTY LINE <br /> f3 <br /> SEEPAGE PITS NUMBER fff"`"""""" WIDTH_ /J�, ft DEPTH p�C,_� _$ <br /> I DISTANCE TO NEAREST WELL T�S ft FOUNDATION. _ft PROPERTY LINE" ._:5 ft <br /> I , <br /> 1 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 /> 1NIMUM 24 UR ADVANC NOTICE REQUIRED FOR INSPECT NS-PLEASE CALL(209)953-7697 <br /> f yt� Q <br /> SIGNED � '-V ��'JITLE DATE / <br /> t / <br /> F f <br /> I <br /> Ar I <br /> BA <br /> rat,4 <br /> 4&10 ton <br /> R <br />' DEPARTMENT SE�OrNLY Sp �vhRO{1MNTp1 <br /> NT <br /> Application p e Date V .1�C Area }HEALTH Ryee6ID4 31b <br /> 1 Final Inspect Date ���/n ❑ SPECIAL-PERMIT-Approved 6y <br /> Character of Soil to Depth f 3 Ft: Pit/Sump Soil Character: C N' <br /> COMMENTS D" "-r a1= AFr-04.4 - 01�= -_9E,- '0 ?ar A­,001r r4`4 4).jC Plro�{rC7— <br /> 1 eeYD �-o M L�1iLL �Br4Gf�727 �'t��/L L A- F`rp� <br /> PE SC Received Check#! Amount Date Permit/ voice# Per ID# <br /> Code INFO By Remitted Service Re uest# <br /> 42-02-001 �Z���ly��i�']�G C] ON WASTE•W'AAT,ERR PERMIT <br /> 12/22/2003 <br />