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I <br /> ONSITE w UWATER TREATMENT SYSTEM L bIIT <br /> SAN JOAQUIN COUNTY_ENVIRONMENTAI,HEA LTH DEPARTMENT 304E WEBER AVE-3"FLL--STTOCKTON CA 95202 - (269)468.3426 <br /> NON-REPCNDABLE PERMIT CALLT(209 953-7(197 FOR INSPECTIONS EXP( $11'EAR FROM DATE ISSUED[JOBADDRESS ' -,_ Z,e�.. ;' L C I •"i \ � CITY/ZIP LL. I`L- ��3�%I -7&c m <br /> IRo555TaTHEH n E, -}r'+ APN r-L-J'��I'�'� I' PARCEL512E .vJ I IL JE,j I/lWNRNANEE )(, 3Lal p1 [�( 1�/r1� PHONEYNERADDRESS �i/�d"1 C.�> ll LG)'�` I'll }/1l AIONTRACTOR P 11 SC Y\S` Y S PHONE <br /> CONTRACTOR ADDRESS Pj2.] 14-(I (P.h 11I )A CITY/STATE)ZIP <br /> LICENSE ❑C-42 - ❑C-36 OTHER NUMBER _ EXP1RA IoNDATE <br /> WATER TABLE DEPFIC - R GEOCRAPHICALINFORMATION: CUDrdiavte9 X - Y IN <br /> O, PERCTEST # lliUILDIN'C PERM IT# LAND USE APPLICATION$ <br /> I VPC OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION - ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENI ❑ DESTRUCTION <br /> INSTALLATION WILLSERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> N EMBER OF LI\I[G U PLES: - SLNIREROFBEDROOMS: NUM1IBEROFEMPLOYEES: <br /> ❑ SEPTIC TANK TTPFJMPG CAPACITY _ gal #OFCOMPARTMENTS <br /> ❑ CREASE IRAP T I'Li M!'G__. _ -_ CAPACITY _ pi #OF COMPARTMENTS <br /> PKG TX PLANT DISEANCETO NEAREST: WELL_____ If fOUNDATION- _ ft.' PROPERTY LME' ft <br /> ❑ LIFT STATION SIZE TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSEDSYs'TEM) <br /> LJ LEACH LINES ❑ LEACIIINGCHAMBERS #OFLINEs LENGTHoFLINE$ ft <br /> DISTAN'CETONEARF,ST WELD - R FOUNOAI'ION_ __ft PROPERTY LINE R <br /> ❑ FILTER RED WIDTH ft LEEMT ft DEPTH R <br /> DE]I'ANCE IONEAHESE WELL - It FOUNDATION it PROPERTY LINE 6 <br /> ❑ MOUNDED NVDTR _ Il LENGTHfl DEPTH it - <br /> DISTANCETONEAREST WILL If FOUNDATION ft PROPERTY LINE it a <br /> ❑ $LIMP$ WEDTII ft LE11TH_ 11 DEPTH ft <br /> DISTANCE TO NEAREST NGLL _ ft FOUNDATION. R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS W!DTII It LENCTH_ R DEPTH ft <br /> DISrANCETONFAREST WELL ft FOUNDATION _ft PROPERTY LINE It <br /> ❑ SEEPAGE PI IS NUMBER WIDTN It DEPTH R <br /> DISTANCE TO NEAREST WEIL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLK ATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORO]MANCE$STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY:.- <br /> . M I N I M L M 24 110E R Al)%,%N(1 NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> bNFD <br /> f TITLE tom.' DATE ' ��• / <br /> J' �Z.TS ,c 19 <br /> V <br /> U 5 <br /> Atr <br /> --_. <br /> EP I ME NT <br /> HE <br /> PA <br /> ApplicationAccepted Bt �'^ � - UL 17T U l Area i - E'Dployee ID#S�i <br /> It nvllnsPeCl9n By.- - _ Dete ❑ SPECIAL PERMIT-Approved by � <br /> CSarvcter of Soil to Depth Of 3 Ft: _ - Pit/Svmp Soil Chvraeter:_ ._ <br /> CONIMEN'TS -.. <br /> PE SC Receivetl Check#/ Amount Dete ce Reg/. invoice# Permit lDp <br /> Code INPo B CvsM1 RA-q tl Servicerm uesl# <br /> 4222001 - ONSITE WASTEWATER PERMIT <br /> 1212➢2003 <br />