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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> ht SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-Y°PC-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDREM 11itI ILcvtla,l< Dr clTv21P ,i'{1l/�.LFuy1 44- 15-336 <br /> a� CROSSSTREEf G-.^LP R8 APN /—��O_Or(o PARCELSIEE GY `ham p <br /> OWNER NAME LbRFI�e.r L4J✓ ('anLG PHONE <br /> OWNER ADDRESS �M ,/J �t>—e / CITY/STATP P SS�a+ti <br /> r CONTRACTOR II 1.-IL4-1 23e e4C(^r_.ti �1 PHONE <br /> p An, (S <br /> CONTMCTORADD0.E95 �PJ I_ O A CITY/STATFJZIP II1CIr{LLQ CA 'f533E <br /> LICENSE Ll C42 0C-36 OTHER NUMBE0. DO-t EXPIRATIONDATE � <br /> ` WATERTABLEDEPTHI D GEOGMPHICALINFORMATION: Coordinate$ X Y <br /> ❑ PERC TEST(S) NUMBER LANG USE APPLICATION It O <br /> TYPE OF WORK: NEWINSTALLATION ❑ REPAIR/ADDITION O ENGINEER DESIGNED/ALTERNATIVE lam. <br /> ❑ REPLACEMENT - ❑ DESTRUCTION <br /> V INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER I2 <br /> NUMBER OF LIVING UNITS: ,,r NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: Eat <br /> O SEPTICTANK TYPE/MFG PT` CAFACRY (.Z on gel BOFCOMPARTMENTS� \/ <br /> L ❑ GREASE TRAP TYPFJMFO CAPACITY gal N OF COMPARTMENTS 1SSr <br /> ❑ PKG TX PLANT DISTANCETONEAREST: WELL R FOUNDATION A PROPERTY LINE it <br /> ❑ LIFT STATION SITE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENcLOEEDSYsTEM) <br /> V W LEACH LINES ❑ LEACHINCCHAMSERS poFLMESQ- LENGTH OF LINES I_C� / fl <br /> DISTANCETONEAREST WELL InrY?' fl FOUNDATION .IAT fl PROPERTY LME S) fl <br /> ❑ FILTER BED WIDTH ft LENOTH R DEPTH fl <br /> DISfANCETONEAREST WELL fl FOUNDATION ft PROPERTY LINE fl <br /> `P ❑ MOUNDED WIDTH fl LENOTH A DEPTH fl <br /> �� DISTANCETONEAREST WELL B FOUNDATION ft PROPERTY LINE fl <br /> W SUMPS WIDTH ;�y fl LENGTH 10_I R DEPTH . It), fl <br /> DIWANCETONEAREST WELL fl FOUNDATION fl PROPERTY LINE ft <br /> V ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH fl <br /> DISTANCETONEARM WELL R FOUNOATgN fl PROPERTY LINT R <br /> ❑ SEEPAGE PITS WIDTH H LENGTH It DEPTH It <br /> DISI'ANCETONEAREET WELL A FOUNDATION ft PROPERTY LINE fl <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. ////// <br /> M I NUM UM 34 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED i/L; ^�A /J.! TITLE L ofnf f-B r DATE 3 d <br /> Q <br /> 4 <br /> u <br /> r - <br /> lime <br /> A <br /> A <br /> IG s <br /> mail µ0 <br /> P <br /> 1 <br /> Ba <br /> DEPARTMENT USE ONLY /1 p <br /> �pplintion Aceepled BY Date `���'�-/�,q3.a_�.3 A. i�7 Employee IDp ©a�� /q9 <br /> Final Impreume BY Data r J /za ❑ SPECIAL PERMIT-Approved by <br /> � Char$Bterol Soll.Depth of3 Fc / Pl ump S011 Chvveter. <br /> COMMENTS <br /> lam PECoda <br /> SC Received CheckBl Amount Date .R. Involttp Permit lop <br /> Cod< INw B u Remised ServlceR UertB <br /> W/ 1 7 1 4 ( azo- 3 3 <br /> 42-01401 ONSITE WASTEW ATER PERMIT <br />