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ONSITE WASTEWATER TREATMENT SYSTEM PER"NNED <br /> L SAN JOAQUIN COUNTY ENVIRONMENTALHEALTH DEPARTMENT INN.WEBER AYE-3"Fl,-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDAESs 17-beL4 �1I,J�� :SRf,9-TDFJiv �D cITY21P Loot 11'j Z=IO <br /> C0.0555TRECT �41I.OF-CTJ F`�rtP"U��L .�-11N`t K�Ij JNS©1\) APN �y/7r) I� �J, PARCEL SII12E �J {tC/liT o <br /> ONVER NAME ( # Si A%C/-1 JP4NJ`-l� PIfONE I$i✓() I'IO-Iy-��'J9L} <br /> OKIERADDRESS I I L N .SF�L-1Fr�N d Q y, CITY/STATEIZIP <br /> CONTRACTOR 514JL1 Darr cL ¢ 17i T L yvu 1 = PHONE(LGL) <br /> CONTRA C)GRADDRESS EOI 5 L L:-12 RJB Ff"$ CONISTATFJZIP 1107L ck <br /> LLICENSE AC42 LI C-36 OTHER NUMBER TY)b _ EXPIRATIONDATE D L6 U <br /> WATER TABLE DEPTH: R GEOGRAPHICALINFORMATION: COordlDateS X Y N <br /> ❑ PERC TEST p BUILDINGPERNIITN LAND USE APPLICATIONN MM <br /> TYPE OF WORK: NEW INSTALLATION ❑ KEPAIWADEHOUN ❑ ENC.INEERDESIGNEDIALTERNATIVE VV <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: Ut RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING U S' ry,1 / pp4NNuMBEROFEDUROOMS: NUMBEROF EMPLOYEES: q <br /> I® SEPTICTANK TYPFJMFG TT-IJEww / FIJI L- CAPACITY 1TnO gal NOFCOMPARTMENTS <br /> LIGREASETRAP TYPEMIFG CAPACITY ') gal MOF COMPARTMENTS <br /> L <br /> ❑ PKC TX PLANT DISTANCETONEAREST: WELL IOO/Y R FOUNDATION sI 'F ft PROPERTY LME '3�01 fl <br /> ❑ LIFT STATION Stu TVPKOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ` ❑ LEACH LINES LE LEACHING CHAMBERS �Q-ZA )L 6 NOF LINES S LENGTH OF LINES U(b l ft <br /> DISTANCETONEAREW WELL IJ5714 A FOUNDATION to Jt ft PROPERTY LINE ZoP'1" R <br /> ❑ FILTER BED WlDrx ft LENGTH R DEPTH R <br /> DIBTANCETONEAREST WELL fl FOUNDATION 0 PROPERTY LINE ft <br /> ❑ MOUNDED WIDTx ft LENGTH fl DEPTH R <br /> DIWANCETONEAREFF WELL R FOUNDATION 0 PROPERTY LINE R <br /> L ❑ SUMPS WIDTH ft LENGTH A DEPTH R <br /> DI.RANCETONEARESF WELL R FOUNDATION fl PROPERTY LINE fl (�E <br /> ❑ DISPOSAL PONDS WIDTH fl LENGTH ft DEPTH <br /> DISTANCETONEAREST WELL fl FOUNDATION A PROPERTY LINE fl <br /> L SEEPAGE PITS NUMBER 21WU x 3G-Qft DEPTH 2S{ ft <br /> DISTANCETONEARFST WELL 1'50*+ R FOUNDATION (GOT ft PROPERTY LINE Is, 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"WS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> V L�/� hl IMUM 26 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)95]469) <br /> L SIGNED '—T TITLE COI-rr4-1LtT�r Ri DATE © {SLG <br /> r <br /> l <br /> 6 <br /> LTTs <br /> J N MkV yeu <br /> ^ H <br /> F <br /> o <br /> LP <br /> ' L <br /> ---------------- <br /> R � <br /> r 7 1 <br /> YPR <br /> �.T DEPARTMENT USE/)%L <br /> APPlicatiof/Ateept/ed�� <br /> Data - G,$ Area �i _ Employee IDN , <br /> Float lnaPeO»w y i "lT ❑SPECIAL PERMIT-Approved by <br /> CharacteTof Soillo DePl oft Fe Plvsump Soil CUR aratter: <br /> �TJMMENTS <br /> PE SC Received CBeedll Amount Dale PermW InvoittN Permit lDM <br /> Cods INFO BY .aVV Remitted Servtoefa enM <br /> L <br /> ONSITE WASTEWATER PERSIIT <br /> =2700 <br /> 12_220D1 <br />