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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-VPC-STOCKTON CP.95202 -(209)468-3020 <br /> NON-REFUNDABLE PERMIT CALL(209)9$3-7697 FOR INSECTIONS EXPIRES'1 YEAR FROM DATE ISSUED <br /> JOBADDRESS r CITU/ZIP y <br /> v( i7�3 <br /> C&A-AA Y, <br /> CROSS STREET APN � (JAP PARCEL 5126:0.c/ f >• <br /> OWNER NAMEIP\ p ���� Pa� PHONE bog- ?12/ <br /> OWNERADDRESS C�JnLI/y/W��'� y Crry/STATFIZIP n <br /> CONTRACTOR 'I `\ V_ ) PHONE <br /> CONTRACTOR ADDRESS CITY/STATEYGPdef <br /> LICLYRE ❑C<2 ❑ -6 OTHER <br /> NUMBER. E"IRATIONDATE <br /> WATERTABLEDEPI'H: ft GEOGRAPHICALINPORMATION: Coordina4a X Y (O- <br /> ❑ PERC TEST q BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INRFALWTION ❑ REPAIR/ADDITION ❑ ENGINEERDESIGNED/ALTERNATIVE /p <br /> ❑ REPLACEMENT ❑ DESTRUCTION U) <br /> INSTALLATION WILL SERVE: I PMIDENCE ❑ CommeaclAcl ❑ OTHER <br /> NUMBEROPLIviSGUNITS: ,01 n NUMBER <br /> ^O_F(�B�E.DROOMS: r� NUMBEROPEMPLOYEPS: <br /> L"PTIC TANK TYPPJMFO 1 T�+ t�V�-(/LCA CAPACrrY 2-.5 gall #oFCOMPARTMEMTS Z <br /> ❑ GREASETRAP TYwmFO CAPACITY. Sell #OFCOMPARTMENTS <br /> ww ❑ PKG TX PLANT DISTANCE TO NRANew: WELL ft FOUNDATION fl PROPERTY LINE ft �- <br /> ❑ WFP STATION SIZE— TYPEOPPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) S� <br /> $/ EACH LINES 13LEACHING CHAMBERS pop Lmms LENGTH OF LINEs `7Y ft ` <br /> -------- <br /> !� 1—T <br /> DISTANCE TO NEAREST WELL 5— FOUNDATION �(� R PROPERTY LINE � � fl <br /> ❑ FILTER BED WmrH ft LENOTH A DRYrH ft <br /> DISTANCETONEARESr WELL R FOUNDATION R PROPERTY LME ft <br /> ❑ MOUNDED WIDTH ft LENGTH fl DEPTH R •���\ <br /> //�� DISTANCE TO NEARPST WELL R FOUNDATION ft PROPERTY LME A j <br /> SUMPS ge WIDTH ft LENGTH ! ft DEPTH T ft /\\�]° <br /> ��++ DISTANCETON REST WELL R FQUNpATION D ft PROPERTYLINE 7 � ft <br /> ❑ DISPOSALPONDS WIDTH ft LENGTH A DEPTH ft <br /> DISFANCETONEAREST WELL ft FOUNDATION ft PROPERTY LME ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCETONEARFbT WELL R POUNDATON ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORE WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE L.�ACW�SAND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED MINIM �A ryypa,E { ED OR In PECTIONS-PLEASE CALL(209)953-7697DATE <br /> e&&j5AlP4A4n-r, ITT <br /> • <br /> t <br /> DEPARTMENT US OpN Y <br /> Application Accepted By Date '3 1 Arra ZLV EmployeelD <br /> Final lnapecOon By L Date 3 � d 13 SPEC_ PE,RMIT-Approved by <br /> Character of Soll to Depth 0173 R: PiUSumP ❑Character: <br /> CO MIy„ ENTS ?�VvY 1'7_.P��6LCR-� !)t.3 rUA<1.A�a.OD {�sTa�t ury O�GI <br /> PE <br /> od SC P R.Ne l LTeck#/ Amount Date pemiB Iovola# Permit lDp <br /> Code INPO B 'Caah RMEDEM SEYviee R REM# <br /> x-lY� l fD 7 SID 3 � <br /> 4242-001 ONSITE WASTEWATER PERMIT <br /> 1111 W] <br />