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t0/yo ONSITE WA' ??WATER TREATMENT SYS' NI PERMIT DEPAf I SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH RTMENT 304 E WEBER 3"FL-STOCKTON CA 95202 - (209)468-3420 S NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED Jtri OB ADDRESS I CITV/ZIP n CROSS STREET �jV I 1 `(I G A(PN QQ?) � `1� s 0� PARCEL SIZE 16. c� o OWNERNAME I eIlj �l^--�A}-/,,-., `PHONE I- 9 OWNER ADDRESS ` O [_y/^•/n 1 Q '^ `--�A I- CITY/STATE/ZIP J J /��y��y�7—/� -5 CONTRACTOR A ,�" A2-t �/ "' 4 PHONFfKW ��✓ / CONTRACTOR ADDRESS CITV/STATE/ZI LICENSE C-42 ❑C-36 OTHERNUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYP&OF WORLLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER �r NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ICI SEPTIC TANK TYPE/MFG A�l.F_iC�LL--• CAPAC Y� - gal #OFCOMPARTMENTS� ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ PKG TX PLANT DISTANCE TONEAREST: WELL ft FOUNDATION ft PROPERTY LME R ❑ LIFT STATION SIZE TYPE OF PUMP E3 r SAND OIL SEPARATOR(ENCLOSED SYSTEM)�EM LEACH LINES J( LEACHING CHAMBER 36612 ��#OF LINES / - LENGTH OF LINES DISTANCE TO NEAREST WELL_6(-ffft FOUNDATION R PROPERTY LINE ❑ FILTER BED WIDTH ft LENGTH ft DEPTH it N DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft y� 1 DISTANCETO NEAREST^ WELL R FOUNDATION PROPERTY LME ft O SUMPS C-7) WIDTH 4' ft LENGTH 1l D DEPTH ft ]- r,r DISTANCE TO NEAREST WELL��r ft FOUNDATION ft PROPERTY LINE R `Iyr ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE R I HEREBY CERTIFY THAT 1 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. MI I+ffiIWVjeMANCE NOTICE.REQUIRED FOR IN. PLF E LL(209)953-7697 ©� SIGNS -- -- -------- --- ----- 1 I-1 - j-'� Womac H rwaa]m rFsi •1PIalIE r OBatlYnlall ps./rZr.K axtA+axm sRu mAA r/]-r rloatolas I I •.FS - L- t Y£ I aw � I I _ A f1 aGm11E YLa1] A, Bum waFal — _ aafaEs uia Dna]-IID mypqea yL Irinl uao 1lgn rMao I I I auR ar NL N ul r- a a.o.aoO tnra'W sAfML 1 I I PA aW1anP I I I oNu REL, . . I - I I JUN f-� I T 1 SAN JOAQUIN ENVIRONM N HEALTH DEP T E HORIZON CHRISTIAN FELLOWSHIP - REVISES-SEPTIC SYSTEM - DEPARTMENT USE PN1,V r� Application Accepted B De[e Area .2-1 (�/ 9 I/ Employee IDN q/ Final Inspection By D ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft, PH/Sump Soil Character: COMMENTS 6e 02-02-139 -mt 02422-142_ "odu fo Go c,&e5 b PE SC Received CM1ecldl/ Amours[ Date Permit/ Invoice# Permit ID# Code INFO CasM1 Re In %' Service Re uest# 2.31 3D g.3G oo )l a 42-02-Ml ONSITE WASTEWATER PERMIT 12/22/2003