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ONSITE WAEWATER TREATMENT SYc' :M PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTh-L;EPARTMENT 304 E WEBER-left -3'°"FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDAQLE PERMIT CAL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS a CITYIZIP <br /> r y� M � <br /> CROSS STREET J��{L�J J APN C) -- <br /> 3 (-50­0PARCEL SIZE ` �Q`5 d <br /> �! <br /> OWNER NAME ` CC PHON <br /> OWNER ADDRESS CITYISTATEIZIP � <br /> � <br /> CONTRACTOR PHONweW <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE Cl C-42 El C-36 OTHER NUMBER EXPIRATI <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> ❑ PERC TEST # BUILDING PERMIT# £-2-,-0 LAND USE APPLICATION#1 <br /> I <br /> TYPE OF WORK: NEW INSTALLATION 0 REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE,, RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 2- NUMBER OF EMPLOYEES: <br /> la SEPTIC TANK TYPE/MFG TB,D CAPACITY / 2-�0 gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE @ <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) (� <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES .2 LENGTH OF LINES 4(0 ft <br /> DISTANCE TO NEAREST WELL S'� �, ft FOUNDATION ft PROPERTY LINE ft IY. <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE f} <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft r <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH f3 DEPTH ft Y ' <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER WIDTH 3 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL 100 FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I 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 /> MINIMUM 34 R AnX4XE NOTICE REQUIRED FOR INSPE/CTTION,S—PLEASE CALL(209)953-7697 <br /> SIGNED TITLE {Sff� JV DATE <br /> MAIN Sr. <br /> sal F r i .ev e r -shbyn. <br /> t;e is p ,1 f,be <br /> N%6* <br /> -.'titnaut wriaen ap,raial from IJ]�' <br /> 115' xl� <br /> C) <br /> ° RUR <br /> JUN <br /> " NUU� �� 3IJ° �71(pl�. ��J -1� '�:,:YI 2$L° 1 <br /> C' SAt3�JJQAcauIENTAL <br /> f `9 '- - -. <br /> I G }'i ` a I-:.?"� •✓' t 'K�� � YIEALTki DEPARTMEN = I <br /> REQUEST DIN SP Iiur <br /> .. - Firt hetito Mntl.Hero.f ti nr�4 eP"rh•••1.6"Iles"'et, 6c�({' �,�,L]L IVII'1 <br /> tl• i <br /> �1 1-1. 4­1 1 <br /> Application Accepted' Date �.S- Area .tea 'Employee 1D#_ Sc qFinal Inspection <br /> Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Dep of 3 Ft: it/Sump Soil Character: <br /> COMMENTS f)LO L-0-T bFrc'-�ca.2lJ F A'l? 45. . 73 <br /> �-f' �.�.�?���-yam 'rr•��71-�•�"��lo��l.�-�.�'.t`�"��d.�r,;,,_,��� <br /> r <br /> d Pn5 <br /> PE SC Received Check#/ Amount Date Permit) Invoice# Permit ID# <br /> Code INFO By Cash Remitted 1 Service Request# <br /> qz._ it /17 l�Li i(�Ft�S' 3?.c•t• (, �-3(ct Q� <br /> 42-02-00: lYL 7 4�b �1�'''1 1iL's " Xld C`c.w, a­pY AD <br /> 12/22/2003 / ONSITE WAST A ET f Y'EtT I <br /> �� aL'f�-_�1���E� GL.� zf:KG`s j "7G�i��✓7.�r�`d �a S�P� �•-•�r� <br />