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` ONSITE WASyy ;WATER TREATMENT SYS•'��"'M PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTR'DlTARTMENT� 304 E WEBEAU4 -3s"FL-STOCKTON CA 9$202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED ^^ ,, N JOB ADDRESS Serol �SSCrJ t2J n/J CITV/ZIIPP Ile /�j� n fl CROSSSTREET J� ' --?J APN !.7l / (LV _D PARCELSIZE YI ) OWNERNAME JDh M TI N�.F PHONE�a5'- I D-1-x44 9 OWNERADDRESS e_ 1 CITY/STATE/ZIP N CONTRACTOR � V F or, /•y Q� /�p I(rn C PHONE��}/- O rOO c CONTRACTOR ADDRESS T�-4-(eD �' WIL, -/ 7 T�J�' _ CITY/STATE/ZIP S& CkA�,I` 9sais �N LICENSE ❑C-42 ❑C-36 OTHER - NUMBE 6 EXPIRATION DATE m- I -OS 0 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y f ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# TYPE OF WORK: 21 NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: /T NUMBER OP Hr1DROOMS: NVMBEROFEMPLOYEES: r� SEPTIC TANK TYPA E/MFG -G CAPACITY Iaan gal #OF COMPARTMENTS Ol ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS El PKC TX PLANT DISTANCE TO NEAREST: WELL Sod R FOUNDATION ft PROPERTY LINE TiJ / It ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) �[ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES 3 _ LENGTH OF LINES 9S 11 DISTANCE TO NEAREST WELL ROn fl FOUNDATION 9'O r fl PROPERTY LINE I - R 13 FILTER BED WIDTH R LENGTH It DEPTH fl DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH 11 LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION 11 PROPERTY LINE Il ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH Il DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl 1 HEREBY CERTIFY THAT I 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. ``��••--yyam�^^ MIUM 24 OUR MANCE NOTICE REQUIRED FOR INS CTIO�NS-PLEASE CALL(209)953-7697 SIGNED �fl� 4 TITLE X{ DATE -- i yyy 3 1 IIOO � 1 ^� V. Y �- na N ')c 497 rLlr .,I a � n •a g a .�c � j .•1 3'n v - � a a A2 iz rPJQ� N 44-49.12, T 00• 1 TP!; YP qb � I CPY po "IS- q 3 U �1 /�/ // (//0/ DEPARTMEN 'EON Y / Application Accepted By yJ/ �' ! o L Date Area _ Employee ID# Final Inspection By Dale (JJ ❑ SPECIAL PERMIT-Approved by Character of Soil toth of 3 Ft: I ump Soil haracler: COMMENTS �n/D? 117 ~ it /}�� F7SC / B =7 SCS932/yp'• , o PE SC Received Amount Dale Permit/ Invoice# Permit ID# Code INPO B Cash Remitted Service Request# 42-01-001 /�//d3 1 �y itr./ / ONSITE WASTEWATER PERMIT 12/2/02 / I .. .