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ONSITE WAS' fEWATER TREATMENT SYS'��M PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH U IARTMENT 304 E WEBER AT"e -3R°FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL2/0'79 9513-716971�FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED JOB ADDRESS I CITY/ZIP S-T-C)C -- Z y CROSS STREET APN I7q'/-57-0 -- .^6p PARCEL SIZE Jr� U o 1 , A OWNER NAME � 'y�,.��y PHONE . OWNERADDRESS `N""�\ .Q CITY/STATE/ZIP 7 0 CEJ CONTRACTOR T 6(-� ✓ ` ✓U��v/L PHONE L �� R1 4 S (00 CONTRACTOR ADDRESS 1 ff0CITY/STATE/ZIPOkk L7 LICENSE ❑C42 ❑C-36 OTHER tA NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# A -03 -601C-i 4- TYPE OF WORK: ❑ NEW INSTALLATION .n KFPAIWADDITION NEERDESIGNED/ALTERNATIVE f ❑ REPLACEMENT 'r4�3,�Ih+(:r Z- sLdp• ICOVE.Q.S� &W&C,1C1•lUt7 &AYf}A/d INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ PKGTXPLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LME R ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES it lA) DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft J DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft ✓ J DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE R ❑ SUMPS WIDTH ft LENGTH ft DEPTH R 1 DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft (� ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft Y-n� DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft R DISTANCE TO NEAREST WELL R FOUNDATION ft 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. `n INIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR IN CTIONS-PfLE'IAS1E CALL(209)953-7697 SIGN TITLE � . �e CEJ YV ,�k CZ DATE 7-7 JO. E N T Y .. U i O h t N Iv 7 U -,.�?-•"i 44^V^S v;::ht'.t4A. .,a.a;i��A ' .'�7BY's%:"•"Yw':2!t O DEPARTMENT U. ON VI p Application Accepted By �. �- Dete I I /I S Q Area 2- I b Employee ID# Final Inspection B, Ail// �_ �� — Date /� /�',0�—Z,,, ❑ SPECIAL PERMIT-Approved by Character of Soil to Ddepth of 3 Pt: Pit/Sump Soil Character: COMMENTS --T-,e sod-, e 5—m,ddy A X=elw,. e44 Il —�e+,� —03—4k, �Sr4 PE SC Received eck# Amount ate Permit/ Invoice# Permit ID# Code INFO fly ash Remitted Service Request# 42-02-001 ONSITE WASTEWATER PERMIT 1222/2003