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r, ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)466.3420 <br /> NON-REFUNDABLE PEI a yCALL(209)953.7697 FOR INSPECTIONS EXPIRES 1,YEAR FROM DATE ISSUED <br /> Joe ADDRESS Ly_l� M 1`-47� D CmZP Lf N OEN /$Z <br /> Flf� iza4D <br /> CROSS STREET APN O°�3—X40—53 PARCEL SIZE JZ,67AeD <br /> s OWNER NAME • ���r �T _ PHoNE /�l <br /> 86�1 <br /> OWNER ADDRESS 1po gJgX CITY/STATERIPPL4A14L-All�-/Q/K23 <br /> CONTRACTOR D1 ON � 6 �) »4"663 <br /> CONTRACTOR ADDRESS • D 'gOXj48/ klj <br /> po <br /> � CITYISTATFJZIP �0� C4"/Cj:�-Z*/ <br /> LICENSE ❑C-42 ,.IC.36 OTHER NUMBER EXPIRATION DATE <br /> I <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION#l <br /> TYPE OF WORK: C NEW INSTALLATION ❑ REPAIR/ADoi noN O ENGINEER DESIGNED/ALTERNATIVE <br /> II REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: G RESIDENCE COMMERCIAL 7 OTHER <br /> NUMBER OF LIVING UNfM NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE To NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) N <br /> O LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES It fV <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O FILTER BED WIDTH ft LENGTH ft DEPTH ft IL j <br /> DISTANCE TO NEAREST WELL ft FOUNDATION _ft PROPERTY LINE ft `1 <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 R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft �\ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE MT)-(SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE RtOUIRED FOR INSPECTIONS-PLEASE <br /> EEyCAALLL((2 �'-.70209)953-7697 �^ i. <br /> SIGNED TITLE �r J/ qV/C7- DATE -CE�Ko <br /> I <br /> A <br /> 0 <br /> I <br /> NT <br /> -Hj E EP + <br /> DEPARTMENTS ON <br /> Application Accept Date IO 30 0 Area Employee 104 <br /> Final Inspection Date 1117!�41O) -j SPECIAL PERMIT-Approved by <br /> Character of Soil to pth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTSSLG _ 7 ��lcZ Ae- 7.t5X J IAZ-1) Gid <br /> 36m .J .S%y'�L�_J•�li�'S.rf•,Ga;i�'1?��zs /�--j'`i�f3-�1 - /�-r1Gc`z �i�3<�/L��,..��. <br /> /'-•4�1�2�Z 3 -ds� _ _ ;#--�3-ei 60�,." -P��a��3,G� 19,y,,,,.� <br /> PE SC ReceivedCheck#! Amount Date PanniV Invoice# Permit ID# <br /> Code INFO B Remitted Service Roguest# <br /> X13 szs. o 1 <br /> J <br /> 42-01 ONSITE WASTEWATER TRTMINT SYSTEM PERMIT <br /> 1 D/4J07 <br />