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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 11 <br /> one, SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-31°FL-STOCKTON CA 95202 -(20v1e-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JORADORElis n7 2 S7• '� . �1 e1 W' `1�n1 yR D. CMa'P ��., K-� qS 21 ^ I <br /> CROSS STREET Zr�j MAl4/H = y, APN I 1 S J' Z CEL SIZE 1 At o <br /> OWNER NAME tQCf F-� HJT., ' FC L ,PHONE,1 (�J��,Y.I3 <br /> OWNER ADDRESS 17 G, VUX l �\ CITYISTATEfZiP ia-L I V.rF <br /> CONTRACTOR PHONE—at`, <br /> CONTRACFORADDRESS f CITYISTATFIZIP <br /> LICENSE ❑C-42 13 C-36 OTHER NUMBER EXPIRATIONDATE <br /> WATERTABLEDErTH: fl GEOGRAPHICALINFORMATION: Coordinate, X Y <br /> PERC TEBT # BUILDINGPERMIT# LAND USE APPLICATION# PA- <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIWADDITON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPIACEMENP ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBEROFEMPWYEES: <br /> ❑ SEPTIC TANK T'PFIMFG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPHMFG CAPACITY gal N OFCOMPARTMENTS > <br /> ❑ PKG TX PLANT DIRTANCETONEAREST: WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ LIFTSTATION SIZE TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFWNFS LENGTHOFLINES. ft <br /> DISTANCETONEARERT WELL ft FOUNDATION ft PROPERTY LINE IT,\ <br /> ❑ FILTER BED WIDTH ft IENGTH ft DEPTH ft <br /> DISGNCETONEAREST WELL ft FOUNDATION D PROPERTY LINE ft <br /> ❑ MOUNDED WIRER D LENGTH ft DEPTH It <br /> DIRTANCETONEARFST WELL B FOUNDATION R PROPERTYLNE 0 <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCETONEARETF WELL fl FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS Wmm R LENGTH ft DEPTH A <br /> DIRTANCETONEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS NORBEn WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> I HEREBY CER TIFYTHAT I HAVE PREPARED THIS APPLICATION ANDTHE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> 04DINANCM STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MIN_ -IMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED � M.--, 7- TITLE _ _ 1-,,~ �- DATE 1 G' <br /> lit A <br /> now <br /> 4 <br /> J <br /> ILL <br /> 77 <br /> R <br /> FI /l C�'1 /I DEPARTMENT SENLY <br /> Application Arcepbd B» J\ ` `_fin \L Dvte y- 1 Area Eio I.Y.IDI <br /> Find inepeefie.By Dote ❑ SPECIAL PERMIT-Approved by <br /> ChoeoeteroT Son to Depth D1`3 Ft: PIUSump Soli Chamber: <br /> COMMENTS <br /> W SC Received AnIBUM Dole Peon" Invoice# Permit IDN <br /> Cotle INFO B Cash RemlHed -b ServiceR aeet## <br /> 15KC0 5 '2 <br /> Nr 42-02-001 <br /> ONSITE WASTEWATER PERMIT <br /> 122USW3 <br />