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` /d1,N "1-f 6.�5-- �?.�; .� <br /> ONSITE WASTryATER TREATMENT SYSTF"" PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DE}�,I'M ENT 304 E WEBER Avt w,"'FL-STOCKTON CA 95202 - (209)465-3420 <br /> NON-REFUNDABLE PERMIT CALL(249)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> 30B ADDRESS CITY/"LIP <br /> CROSS STREET L- J s/CJ ,I� {�} APNJ "SY�//� �1+ P RCEL SIZE . <br /> c <br /> OWNER NAME J�It ILSG�,q U �{� Fye - PHONE <br /> 0 <br /> OWNER ADDRESS J 1 CITYISTATE/ZIP <br /> CONTRACTOR /C�f� �f_J7"if L / 4•�J. � _ PHONE <br /> CONTRACTOR ADDRESS} ce- �' fZJ j--e— CITY/STATE/ZIP c% <br /> LICENSE ❑C-42 - ❑C-36 OTHER NUMBER- EXPIRATION DATE 7c3 <br /> t WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X y <br /> I <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADDITION Q ENGINEER DESIGNEDIALTERNATIVE <br /> ❑ 'REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ! ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Q LEACH LINES 21 LEACHING CHAMBERS Cf Z #OF LINES _ LENGTH OF LINES <br /> Yf DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> IJ DISTANCE TO NEAREST WELL ft FOUNDATION_ ft PROPERTY UNE ft <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH <br /> ft <br /> � DISTANCE 70 NEAREST WELL It FOUNDATION— ft PROPERTY LINE ft <br /> i❑ sumps WIDTH It LENGTH ft DEPTH ft � <br /> DISTANCE TO NEAREST WELL fit FOUNDATION ft PROPERTY LINE ft � <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS WIDTH -_ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL � ft <br /> y c7 ft FOUNDATION_ •'z.t3 R PROPERTY LINE 7-L) , ft <br /> I I HEREBY CERTIFY THAT[HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIM M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE;CALI.(209)953-7697 <br /> SIGNED <br /> k _.. TITLE I , , r!/.au�23/^ DATE - <br /> vf 3nV3 A <br /> 5�r <br /> �'4. � •C1:::^L-fis fY�-.�:� rT-j -71 <br /> v-r-ti <br /> REC <br /> C: V uj ti <br /> N ' Q <br /> LJ JOA1 <br /> is <br /> / ­-­7�­­;j� ...­ <br /> .- . . <br /> DEPARTMENT SE ONLY <br /> Application Accepted By Date /�� C% Arca �f f Employee ID# > >I 4,(.0 <br /> Final Inspection By <br /> D0 <br /> Date 0 SPECIAL PERMIT-Approved by <br /> Character of Soil to epth of 3 Ft: Pit/Sump Soil Character: <br /> COMMS TS (`".r✓� cr a .�P_[.� r! [' �.t .c� :za_ ct 2' fY a c� IGC 'z r,.� t_cr�C/ �u� .512 {/r t .z=1. <br /> F. <br /> zz <br /> ate <br /> yZ�y� y 1 <br /> PE SC Received hec Amount <br /> ate permit! <br /> Code INFO B Cash Remitted DInvoice# PermitlD# <br /> Servicem Request# <br /> i� <br /> 42-0I-061 <br /> 1212/02 ONSITE WASTEWATER PERMIT <br />