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ONSITESTEWATER TREATMENT SYSTEM RMIT N SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3`°FL-STOCKTON CA 95202 -(209)468-342 ,, NON-REFUNDABLE PERMIT I �C.ALL 209 953-7697 FOR INSPECTIONS EXPIRES i YEAR FROM DATE 19SULD JORADDRESS 3 yo I,v G. -t (t-( CITY/ZAP 4e.t + Lw 1J G � CROSS STREET 7[%-- APN O C 3- 0'7C" Z-! _ PARCEL SIZE OWNER NAME �I �� .J J I' PHONE -1C% OWNERADDRE53 �•)/L1 Lw, GvCsi,.-a+�` ,.f CTTY/STATElZIP_ CONTRACTOR PHONE CONTRACTOR ADDRESS CrrYISTATEIZIP fav LICENSE ❑C•42 O C•36 OTHER NUMBER EXPIRATION DA WATER TARLE DEPTH: - R GEOGRAPHICAL INFORMATION: Coordinates X ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: O NEW INSTALLATION ❑ REPAIRIADDrFON ❑ ENGINEER DESIGNEDIALTERNATIvE ❑ REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMEReIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTICTANK TYPFJMFG CAPACITY gal #OFCOMPARTMENTS , ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ PKC TX PLANT DISTANCETONEAREST: WELL ft FOUNDATION R PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENcLoSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS P OF LINES LENGTH OF LINES R W DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft -4) ❑ FILTER BED WIDTH R LENGTH ft DEPTH R n D[STANCETONEARESr WELL ft FOUNDATION R PROPERTY LINE R ❑ MOUNDED WIRTH ft LENGTH R DEPTH It DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R ❑ SUMPS WtM R LENGTH ft DEPTH DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH It JI-y I DISTANCETONEARCST WELL R FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 24 HO A V NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED - �- TITLE �n't^•`^'� DATE -T1AE rr DEPARTMENT SEIk J, I Application Accepted Date LGA Area W Employee IDN .3 y Flux[inspectkn By Date ��7-4,�3 13 SPECIAL PERMIT-Approved by Character at Soil to Depth Of 3 Ft: 11 PIVSBmp Soil Character: COMMENTS AjE.+tOL/ VA-) QF-Sr-4 . "0 yQ�2 i U ��a t 1 a C>nJ FILAL- O LAA a&.9- 77.tIS �.��'Ir�4s R [ANSI-L-t-7ltZ7a.J-rt� S�-� r rt 7-94+�� 12_�LG s CS %-� r �ee.M� S.0 N t Aj S w CDA/,OI-170. -C.ar� r f%—fJ PE SC Received heck#! AMORBt Date PermlU Invoice# Permit IDN Cade INFO By Cash Remitted Servkce Request# zt 7s Lt 38 D 42-02-001 (-z J e-04-L. - M F.._) "'T-C SF- E-U 6-7 Zt.E V, S E O LJM 16—le--' pNSITE WASTEWATER PERMIT IM212003 ,.t.As p.��sT?a-J t'fS /}- (wn0NAt. C{-C.e 1 F.✓Lt.C.>c LAW-L7-f me r.! u,te p-jVr44E F-L4C-4 111F'r-CA- p,,cc jr St--SK 9,6A ASis fial�n�ut% MN .