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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3-FL-STOCKTON CA 95202 -(209)46&3420 <br /> NON-REFUNDABLE PERMIT CALL 209 95}7(197 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS //19� SdaTH M4Rf7WJF✓Ad Q) anaAr ZA71,wa? 95r33LI '^ <br /> n 1� �P' �•/Q n <br /> CROSS STREET (`OT,4 QQitY APN If/-U�—W PARCEL 512L ��/��G <br /> OWNER NAME 1�URD/P KEGLEI/ PHONE <br /> OWNERADDRFSE //Ff.9? Sou77J/YI.1rJT/{gV CTrY/STATFIZIP 1A'r*e0 0 CFL gO30 <br /> CONTRACTOR COAT U C(rN PHONE <br /> CONFRACTORADDRFSS CRYNTATEIGP 9 S <br /> LICENSE ❑C-42 0C-36 OTHER NUMBER EXPUATIONDATL <br /> WAT RTABLE DEPTH: N I' ft GEOGRAPHICALINFDRMATION: CoordleateT X Y IV <br /> PERCTEST # Z. BUILDING PERMIT# LAND USE APPLICATION#r4qnv12w 16 <br /> TYPE OF WORK: U NEW INSTALLATION ❑ REPAndADDrr'ION ❑ ENGINEER ESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATIONWILLSERVE: L3REMOENCE C1 COMMERCIAL El OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBEROFEMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MEG CAPACITY Eel #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFO CAPACITY pl If OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETONEARESr: WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ LIFTSTATION SRL TYPE OF PUMP ❑ SANDOILSEPARATOR(ENCT.09LOSYS1EM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLiNES LENGTHOFLMES it <br /> DISI'ANCETONGREST WEIR ft FOUNDATION R PROPERTY LINE R <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH it <br /> DIWANCETOINEAREST WELLR FOUNDATION it PROPERTY LME R <br /> ❑ MOUNDED WIDTH R LENOTH a DEPTH ft <br /> DISFANCETONEARLSr WELL it FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WmTH ft LENOTH ft DEPTH R <br /> DISI'AISCHTONEARESi WELL It FOUNDATION R PROPERTY LINE A <br /> ❑ DISPOSAL PONDS WIDrR ft LEN" R DEPTH ft <br /> DISI'ANCETONEARE4T WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ SEEPAGE PITS NumtEe WIDTH ft DEPTH ft <br /> DtSTANCETO NGREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> I HEREDYC RTIPYTHATI AVE 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 /> M M 21 HOUR ADVANCE NOTICE REQUI RFD FOR INSPECTIONS-PLEASE CALL 17091953-7697 <br /> SIGNED TITLE ONNL+( DATE g'Y���✓ <br /> SON <br /> iWi <br /> M <br /> V <br /> t <br /> 43 ARTME <br /> Applk.tion Arapt Dew_- �..Ara E.ploya ID#(f'E.EIC] IIA/ YR <br /> Plnal lmpatlon By Date F/Jn/ny ❑ SPECIAL PERMIT-Approved by <br /> Chencfer of Soil to n Depth of 3 FR USump Soil Character: <br /> COMMENTS HJ x J 1..-.�. /..A.,J.. r c..JrJ <br /> "V 6nrrrralr-��Cu4� r {fir k cy9eY.mflula .TMJ— F��--Ctu^'� - %5 <br /> a�f{e(�a Foix r--► .P41r /6 7../N f•.Li Jss ° /n..�•..� rT�y" E.'IsD.p'S) <br /> / W ^✓� <br /> 4CPESCRalved Cha Auot Perm1U aJA' <br /> IXPD B <br /> ash RemlRed Date Scrvlcc R ueEt p IBvoke# Permlt lDB M,h <br /> C, <br />