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ONSITE W, -;,vVATER TREATMENT SYS'r'�: PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEAL*!11 DEPARTMENT 304 E WF.DF. -3""FL-STOCKTON CA 95202 - (209)468-3420 NUN-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS � EXPIRES 1 YEAR FROM DATE ISSUED Jon ADDRESS ^S / ) 6'y Z ' L CITY/ZIP /�}t4A�1ii•4- -�� LJ L Itl N /rte CROSS 2-U `-'�? O / � �y• T- CROSS S'I'RE:E:'1' y ^^PARCEL SIZE00 OWNER NAME LkA f ✓/L L (3- Iiy.)�yr_ Z._. PHONE •1 L; y f� OWNER ADDRESS ITy ` CITY/STATE/ZIP S CONTRACTOR C./ Il�n �' \ " 1y PHONEAc. f 7 CJ Lt—T �-L'r:S; CONTRACTOR ADDRESS CITY/STATE./ZIP rig In it LICENSE: ❑C-42 ❑C-30 OIIIFR NUMBER Ex I DA WA'I"F.R TAIIIA:DEP'1'll: _ It (:I!O(:IL l'lil('A1.INI;ORMA'I'ION: Coordinates X Y ❑ PERC TEST # I I BUILDING PERMIT# ` LAND USE APPLICATION# TYPE OF WORK: ig NEW INSTALLATION ❑ REPAIR/ADDITION Ll----"ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: ell '/ NUMBER OF BEDROOMS: ! NUMBER OF EMPLOYEES: 0--SEPTIC TANK TYPE/MI;G rC Y �l S'0 o CAPACITY ` �)Cc�� gal #OF COMPARTMENTS >_ CI CREASE TRAP TYPE/MFG _ CAPACITY gal #OI'COMPARTMENTS 1 ❑ PKG TX PLANT DISTANCF.TO NEAREST: WELL. / +� CI it FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE: TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) J ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL fl FOUNDATION fl PROPERTY LINE ft FILTER BED WIDTH C1 ( i't LENGTH { JU { ft DEPTH i� L A�;t- ft DISI'ANCE'1'O NEAREST WELL 10,: f- 11 FOUNDATION fl PROPERTY LINE fl D MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE To NEAREST WELL. ft FOUNDATION it PROPERTY LINE ft ❑ SUMPS WIDTH fl LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL 11 FOUNDATION f1 PROPERTY LINE ft D DISPOSAL PONDS WIDTH 11 LENGTH ft DEPTH fl DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft D SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL 11 FOUNDATION fl PROPERTY LINE ft 1 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. MINIMUM 24 HOUR ADVANCE,NOTICE REQUIRED FOR INSPECTIONS-PLEASE;CALL 1209)95;-7097 CC, __ /�� SIGNED � .��, _-_ _-- '1'I"1'LET,C,vL�-s/-=^�z-� DATE �-- O� 90r C� — — — — — PROPOSED FAL I_z_R BED ' SEE DETA/L S SHEET 9) �- 4 P. l!C. LEACHLINE 1 I I Ij 4 ON CENTER TrIo. II�IIIIIIIIII /0 I IIII H4I-H }--II i 111 l l l A IIIIIIIIIIII I Jor L_- I 'i- / O WWI- Q� �s 1`17�rtfirCrl I A J5' IIII 9 50, I�VVAR'TMENTll IC NLY' L Application Accepted By - Date Area Employee ID# Final Inspection By _.__._.. Date ❑ SPECIAL PERMIT-Approved by l4 I Character of Soil to Depth Ft: iUSump Soil Character: COMMENTS � Z PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# ~ Code INFO 13v Cast Remitted Service Request# 1.54; 0do /�• ONSITE WATER PERMIT 42-02-001 12122'2003 j/a,7 /�i S .L L•� i'L�i1Jil1 'ij/7�'j',t'ci� / XW;-5 �9jzt7z.