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ONSITE WAS e"WATER TREATMENT SYS-1 A!I PERMIT IAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEI•ARTMENT 304 E WEBER Ar 3Rn FL-STOCKTON CA 95202 - (209)468-3420 /NON-REFUNDABLE PERMIT c� CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROMDATEISSUED 1 JOB ADDRESS ZZ CROSS$THEFT Ly T C-�-�i 6�'�� APN 613— C'1 C% --`-f PARCEL SIZE •� > OWNER NAME z— {��j PHONE 7!z— Z-7 OWNER ADDRESS + CITY/STATE/ZIP :�/-)0/ &A Q,5 T l ' CONTRACTOR PHONE f CONTRACTOR ADDRESS CITYISTATE/ZIP LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE lil WATER TABLE DEPTH: fl GEOGRAPHICAL INFORMATION: Coordinates X Y i ❑ PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION#.: /V- aS- &to TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADDITION ❑ ENGINEER DESIGNED IALTERNATIVE ❑ REPLACEMENT - ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ CREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ PKG TX PLANT DISTANCF,rO NEARFST: WELL ft FOUNDATION ft PROPERTY LINE fl ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) N LEACH LINES 13 LEACHING CHAMBERS #OF LINES LENGTH OF LINES !'� �`5 fl N DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft N { ❑ FILTER BED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH tt DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL FOUNDATION ft PROPERTY LINE ft 1 L3DISPOSAL PONDS WIDTH ft TH ft DEPTH ft DISTANCE TO NEAREST /W/ELL ft FOUNDATION ft PROPERTY Y LINE ft ❑ SEEPAGE PITS NUMBER WIDT ft DEPTH ft DISTANCE TO NEAREST WE ft FOUNDATION ft PROPERTY LINE ft I 1 HEREBY CERTIFY THAT I HAVE PREPARED T S APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,S- TE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. N TNI UM 24 )yR A ANCE_NO ICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 _ SIGNED !�"� TITLE '�/LJ DATE U3 � t;. DEPARTMENT USEONLY Application Accepted K, Date7211`t�GLS� Area Employee[D# Final lnspec'on By Date 0 SPECIAL P RM1T-Approved by Character of Sail to Depth f 3 Ft: PiUSump Soil Character: COMMENTS P4- 1-6 - �,•(Cl ,rr + 2-' S r7 f-0 tai. /� ,-7 S ;==i L�«L�y-{ L��..s E s t s-rr t� �..- - :�c,- t^E�-n !�,4y/O o n1� �•G:.0 (_<;I rr�r PE SC Received hec Amo nt Permit/ Code INFO B ash Remitted Date Service Request# i cel per ID# 42-02-001 r�� /`j�� Q ONSITE WASTEWATER PERMIT 12/22/2003 >r_