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WATER TABLE DEPTH: R GEOGRAPIIICALIN FOHMATTUN: CoordiBaleS % y ❑ PERC TEST (S) NUMDFR LAND USE APPLICATION H TYPE OF WORK: ❑ NEW INsrAt LATION ❑ RLI'AIR/ADDIT ON ❑ ENGINEER DE-SIGNEb/ALTERNATIVE 1' ❑ REPLACEMENT - Dk:.crl(urnon INSTALLATION WILL SERVE: ❑ RE:SIDENC6 ❑ COMMERCIAL ❑ O'rHER NUMBER OF LIVING UNI"r5: N UMBER Oh BEDROOMS: NumitER (EP EMPLOYEES: E �1 SEPTICTANK TYPE/M FC: ,i_. CA!'ACI'I'1' (.,al HOF COMF'AHTM!!NTS 1 L) GREASLTRA!' TYPE/Mrc, CAI'n(:rIY E;II NOF L'OMPARTMr'N 1'S ❑ PKGTXPLANT DISTANCETONEAREST: WELL 11 FOUNDATION R PROPERTY LINE Il ❑ LIF r STAT 1ON SITE: TYPE: OF PUMP ❑ NAND OIL SF.PARATO]t (ENCLOSED SYSTEM) ❑ LEACII LINES ❑ LEACIIINCCHAMBEHS 0OFL)NES LIENG111 OFLINI:s R DISFANCHTO NEAREST WELT, 11 FOUNDATION 0 PROPER FY LINE R ' ❑ FILTER BED WE"T" 11 LENGTH R DEPTH ]t DISTANCE TO NEAREST WELL 11 FOUNDATION_n PROPERTY LINE R ❑ MOUNDED WIbtII R LENGTH R DEPTH 11 DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTYLINE R ❑ SUMPS WIDTH R LENGTH R DEPTH R DISFANCETO NEAREST WELL R FOUNDATEON R PROPERTY UNE R ❑ DISPOSAL PONDS WIDTH It LENGTH R DEPTH H' I DISCANCETO NEAREST WELL• R FOUNDATION_ft PROPERTY LINE R I ❑ SEEPAGE PITS WrDTII A LENGTH R DEPTII R ( DI.SrANCETOiNEARESr WELL R FOUNDATION R PROPERTY LINE R 1 I I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULESANDREGULATIONS OF SAN JOAQUIN COUNTY. MWMUNII 2 OUR ADVANCE, NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL (2091953-7647 I SIGNE �t_'r_/� l/:,_ �.— TITLE: DATE d. I j II .•r ;_ j j 1 I I 1 I I _( (, pudw I 1 ) I+ I A2&4 1 ti Y Of, l j I)I FP I&ITIE-0 . UCYAkTN1EN-J'TIJSE ONLh Appl cation Final Inspe Aon 11 c Date — J Arca Z Employee IUR�-J Char i uspectlBn Date �PI `,Z 3 _ ❑ SPECIAL PERMIT - Approved by Chararlcr of So Eh 3 PI: PIusu , Soil Charatle COMMENTS � E PE SCI Received CI]ecklll Amount Permit! Cods INFO B as Remitted Date Service REguest N Invoice 9 PermH IDM .S A Oa 42-01 -ON L a 0 A r. ONSITE WASTEWA""�R_ ~ SYSTEM SAN JOAQUIN COUNTY ENVtRONMENTAL HEALTH DEPARTA1EM NON-REFUNDABLE PERMIT .EATMENT PERMIT -.-0 304 E WEBER AVE -3-171.- STOCKTON CA 95202 (299) 468-3420 CAL1, (209) 953-7697 FOR INSPECTIONS'EkPIRES 1 YEAR rROMy DATE kSUED 1 JOB ADDRESS ry �� _ CF lU cri-vau- Ck�C 12.5 7 -;Z CNPSS S'TNF.k�f .1/ li l -3'V a APN C/ ! l7V - �� PARCEL 51%k; U.� ! OWNER NAME V,I I %}I.(� - it ,.y✓1 �, � UiqCf4 PIIONk. OW'NE-R ADBHESS _I t� J�,, f'I{y,[�- CITYISTATEI2:IP I C(.)NTRACTON PHONE CONTRACTOR ADDRESS �,�� /'N�r S'r/C7b9 / 1 %j�(, CITYIti�tTA7k'1'LD' i4{ --k- LICENSE (3C-42 ❑ C-36 OTIIER NUMBER 63(211 6 3 (2-7 1 EXPIRATION DATE l 3D od `IS WATER TABLE DEPTH: R GEOGRAPIIICALIN FOHMATTUN: CoordiBaleS % y ❑ PERC TEST (S) NUMDFR LAND USE APPLICATION H TYPE OF WORK: ❑ NEW INsrAt LATION ❑ RLI'AIR/ADDIT ON ❑ ENGINEER DE-SIGNEb/ALTERNATIVE 1' ❑ REPLACEMENT - Dk:.crl(urnon INSTALLATION WILL SERVE: ❑ RE:SIDENC6 ❑ COMMERCIAL ❑ O'rHER NUMBER OF LIVING UNI"r5: N UMBER Oh BEDROOMS: NumitER (EP EMPLOYEES: E �1 SEPTICTANK TYPE/M FC: ,i_. CA!'ACI'I'1' (.,al HOF COMF'AHTM!!NTS 1 L) GREASLTRA!' TYPE/Mrc, CAI'n(:rIY E;II NOF L'OMPARTMr'N 1'S ❑ PKGTXPLANT DISTANCETONEAREST: WELL 11 FOUNDATION R PROPERTY LINE Il ❑ LIF r STAT 1ON SITE: TYPE: OF PUMP ❑ NAND OIL SF.PARATO]t (ENCLOSED SYSTEM) ❑ LEACII LINES ❑ LEACIIINCCHAMBEHS 0OFL)NES LIENG111 OFLINI:s R DISFANCHTO NEAREST WELT, 11 FOUNDATION 0 PROPER FY LINE R ' ❑ FILTER BED WE"T" 11 LENGTH R DEPTH ]t DISTANCE TO NEAREST WELL 11 FOUNDATION_n PROPERTY LINE R ❑ MOUNDED WIbtII R LENGTH R DEPTH 11 DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTYLINE R ❑ SUMPS WIDTH R LENGTH R DEPTH R DISFANCETO NEAREST WELL R FOUNDATEON R PROPERTY UNE R ❑ DISPOSAL PONDS WIDTH It LENGTH R DEPTH H' I DISCANCETO NEAREST WELL• R FOUNDATION_ft PROPERTY LINE R I ❑ SEEPAGE PITS WrDTII A LENGTH R DEPTII R ( DI.SrANCETOiNEARESr WELL R FOUNDATION R PROPERTY LINE R 1 I I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULESANDREGULATIONS OF SAN JOAQUIN COUNTY. MWMUNII 2 OUR ADVANCE, NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL (2091953-7647 I SIGNE �t_'r_/� l/:,_ �.— TITLE: DATE d. I j II .•r ;_ j j 1 I I 1 I I _( (, pudw I 1 ) I+ I A2&4 1 ti Y Of, l j I)I FP I&ITIE-0 . UCYAkTN1EN-J'TIJSE ONLh Appl cation Final Inspe Aon 11 c Date — J Arca Z Employee IUR�-J Char i uspectlBn Date �PI `,Z 3 _ ❑ SPECIAL PERMIT - Approved by Chararlcr of So Eh 3 PI: PIusu , Soil Charatle COMMENTS � E PE SCI Received CI]ecklll Amount Permit! Cods INFO B as Remitted Date Service REguest N Invoice 9 PermH IDM .S A Oa 42-01 -ON L a 0 A