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vr.a.rr I`- <br /> L TWPL I MwwP I CR 1 FXCIA I H"CIY I OTO I CIVI YCKMI I <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEgLTI DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202,(209)666-3520 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jos ADDRESS Iio+o�jC�7�CA_!,{• l-/AJN KID. > CITYZP <br /> CRO6SSTREET !(S�.'•'{A Vv• APN OS-3-1/0 -04 PARCELSIZE go ' y <br /> OWNER NAME �{,p'S It II.le I- PHONE 31D&- <br /> • OWNER ADDRESS RD= YwJI T rT CRYISTATEMP V I GT0X0 CIA R9,Z.53 <br /> CONTRACTOR Ll%/e � 0-4 <br /> O#`fAjj_ ($e0EMyyjg44jUMe;ATfAt 101 <br /> PHONE 3 -037W A Q <br /> CONTRACTORADDRESS W- OMC .i1 � CM/SIATIZP L�DIr LST r�z'P-) <br /> LICENSE ❑C42 QC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRA'PHMALINFORMATION: Coordinates X Y <br /> PERC TEST # Z BUILDINGPERMIT# LAND USE APPLICATION$ <br /> TYPE OF WORK: ❑ NEW INSTgLLATON ❑ REPAIRYADDITION 0 ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ CAMMERCWL ❑ OTHER } <br /> NUMBER OF LMNG UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPEIMFG CAPACITY gal #OFCOMPARTMENTs <br /> ❑ GREASETRAP TYPFJMFG CAPACITY gal #OFCDMPARnUENTS <br /> DISTANCE To NEAREST: WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT C! SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLINES LENGTHOFUNES ft <br /> DISTANCETONEAREST WELL I ft FOUNDATION ft PROPERTY LINE it <br /> ❑ FILTER BED NRmH it LENGI H R DEPTH It <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE it <br /> ❑ MOUNDED NOTx ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL 1" fl FOUNDATIONft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE it <br /> C1DISPOSAL PONDS LMOTx it LENGTH it DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE it <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH it <br /> • DISTANCE To NEAREST WELL it FOUNDATION ft PROPERTY LINE It <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BEGONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 1 MUM 2 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE "wA1vt-7'yr;A.AT DATE - -« <br /> 39 I <br /> =4 tic9 WM <br /> 76'j 0 p A� dtl <br /> o� @ 'S 1 Asa° o M�bbyi-/t, <br /> s 11 by^ <br /> ff _. Z 8 OrNbs <br /> C Z'� <br /> aLINK ' <br /> Ap A 1 4 <br /> (/_'�f ( DEPARTMENTUS ONLY <br /> Application Accepted By ('��I Date (- /�j Area Employee lD# %/ {-z) <br /> Final Inspection By Data b ❑ SPECIAL PERMIT-Approved by <br /> ChanICter of Soil to Depth of 3 FC P'rtYSump Soil Character. r <br /> COMMENTSr l-LI R n <br /> L(rA.O.TViK /!rynN-fvtiv� /L 1 <br /> • J <br /> PE SC Received Che° Amount Permit/ <br /> Code Ixso B RemittedDate Service Re oast# Invoice# Permit l0# <br /> " 2 512 <br /> 42-01 <br /> •�••r� ONSITE WASTEWATER TRTMNT SYSTEM PERMm <br />