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r � <br /> ONSITE WA 'EWATER TREATMENT SYS ;M PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALT�EPARTMENT 304 E WEBEFr4 -3"'FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT e, CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM TE ISSUED <br /> JOB ADDRESS �Cl' �O ST 0TY/ZII' <br /> CA�/7 �Z I -1 <br /> APN 5 1+00K PARCEL SIZE I ' ,' p <br /> CROSS STREET r p� r,/ <br /> OWNER NAME L,-! S`CN `C./`�7�C:/•� Cc'Lti��t 4777b / C2,4 JC'r(�ekl �S PHONE <br /> CITY/STATE/ZIPOWNFRADDRESS ( <br /> CONTRACTOR <br /> PIONt; L/C1C-1/440 <br /> / j Z 2 /O —J <br /> D <br /> i CTvltirvrt>CONrRA(TOR ADORES~ 5 <br /> /zip- <br /> LICENSE <br /> cJ <br /> ❑C-42 ❑C-36 01HFR _ NUMBER �— _ EXPIRATION Dnrt: <br /> NVATER TABI.t:DtarrH: fl GEOGRAPHICAL INFORMATION: Coordinates X <br /> ❑ PERC TEST # BUILDING PERMIT# yy'9j(/LAND USE APPLICATION# <br /> TYPE OF WORK: t< NEW INSTALLATION ❑ —REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL OTHER C.AnU' <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> MICS -) sep1PJ <br /> L3 SEPTIC TANK TYPE/MFG E�L CAPACITY '7377z' rgal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ` <br /> PKG TX PLANT DISTANCE TO NEAREST: WELL-> hod 4I ft FOUNDATION >5 ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) C� <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES tt <br /> DISTANCE TO NEAREST WELL. ft FOUNDATION ft PROPERTY LINE ft <br /> FILTER BED WIDTH JV ft LENGTH V tt DEPTH /( fl <br /> DISTANCE TO NEAREST- WELL > t•OC 1'R FOUNDATION fl PROPERTY LINE��_1�i ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH Ft <br /> DISTANCE.TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE f[ <br /> ❑ SUMPS Wllrl'tl fl LI:NOMI 111 DItl'T'11 _ ft <br /> DISrANCETO NEAREST WELL Il FOONDAIION Il PROPERTY LINE: It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE tt <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERT•IFN''THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> N11 UM 2,4 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED { TITLE �/u'r� Z DATE Z 3 <br /> A <br /> NIR <br /> EP R Ari='� <br /> ,DEPARTMENT USE LY YJ <br /> Application Accepted By C �u=1Ct d�G' /Date S I Arri � 1 w Employee ID# <br /> Final Inspection Bye` ` ;'t <br /> Dat -5 2vp 1 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> C'O ENTS ) d f r f L�f1�jl <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO BY" Cash Remitted Service Request# <br /> ''4 StZ OD 13 1.30 <br /> 4 02-00I �' �./- �'����r..yp �- �z'�t'' (/ �/!��/CQ_ (06NSITE yp. <br /> ! f w Ptq rjAI AA, r,4A AM/) S WAT M�/ oh.: <br /> 12222007 L 0 T�vV InA^ <br />