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ONSITE WAS �WA'1'1?R TREATMENT SVS' M PC, RMIT <br /> SAN J0A0IJIN COUNTY E:NVIRONMEN'I'AI,IIEAIA'H DF:PAR't'MIXl' 3114 IS Wt:sER Avv, -3°"FL-STOCKTON CA 95202 - (209)4611-3420 <br /> NUN-REFUNDABLE PERMIT CA I.I.(209)953-7697 FOR INSPEC TIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS 37/C?0 sL7Lfj cA ClTv/zIP -7_/Z4C51 93 3114 1 <br /> CROSS STREET // �1/y I �. APN r�!✓..i� 'C✓�SC� ""�(./ PARCEL SIZE �r/..� �rc[y v <br /> o <br /> OWNER NAME f/7// Js9 1AA _ �PHONE �6 •rS--f4]- y �-3- a le G1� IyaOWNER ADDRESS CLI'11STATE/ZtP cA <br /> CONTRACTOR HONE l / /40Jr <br /> s� <br /> 3 <br /> CONTRACTOR ADDRESS ,0 J3,0 X 'S- - CITYISTATEIZIP -C !C C f? <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE;Dmmi- '�' /3�� ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 14 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DE [GNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UMTS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #pFCpMPARTMENTS <br /> ❑ GREASE TRAP TYPE/NI FC CAPACITY gal N OF COMPARTMENTS J <br /> ❑ PKC TX PLANT DISTANCE tO NE:ARCST; Whl.t. Il I'OIINI)n'I I[1N 11 PROPERTY LINE 11 O <br /> ❑ LIFT STATION SIZE: Tvm.:OE I'I NIP ❑ SAND OIL SEPARATOR(ENCLOSEDSYSTEM) (� <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS 1t OF LINES LENGTH OF LINES ft J <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER RED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION 11 PROPERTY LINE ft <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 ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH J1 DEPTH ft �} <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMnF.R WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 IIEREBY C' 'IFY THAT I HAVE:PREPARED THIS APPLICATION AND THF:WORK WILL BE,DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> .•'�OR INANCE5,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 5 I 101 IR ADVANCE;NO'TIC'E.REQUIRED FOR INSPEC•1IONti-I'1.EASE CALL(209)453-7647 <br /> SIGNED 16,7�C i ,�- 'TI'TLE dos/A/E2 DATE <br /> V P 14 1. f <br /> 14 1 <br /> s <br /> N� Y <br /> IN U! C <br /> eA <br /> T p N pL <br /> - - -- — - - <br /> PARTMENT l SE ON .Y � 'r^ 4 <br /> Application Accepted By T Arca � Employee IDN l <br /> Final Inspection By �/� �'�` Date G ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to De 01`3 Ft: PitlSump Soil Character: <br /> COM ENTS "(1j, s" '-,L,— <br /> 7 <br /> PE SC cci Amount Date Pcrmit/ Invoice# Permit IDN <br /> Code INFO r1fy Remitted Service Request# <br /> 4z-n2-Dnl ONSITL WASTEWATER PERMIT <br /> I D2212003 <br />