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ONSITE W ' " TEWATER TREATMENT S`��IITEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEAIw;f DEPARTMENT 304 E WEBER.AVE -3°°FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS /� /,1 c r F ( -j. 'j C'I l•-i' CITY/ZIP '-) 5 .1L CROSS STREET \�'1 wA 1 t F s+ C- i1 APN i) Sf 7- b O - }"p PARCEL SIZE 4 a J { } f ` l °o OWNER NAME 1 f i 1 IC 'I,4 �I � V Ir{ tC PRONE�Y V `1 ,�1 A/c, 1 ' ( l I' OWNER ADDRESS 5"-190 <! 9!//�/y/11 Y,n/ f"f 1,"" L / CITV/STATE/ZIP .S fJ,ul T`:';,:�.y ( •%� `t'„j(�f ¢'. CONTRACTOR PHONE I CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑C-42 ❑C-36 OTHER NUMBER ExPIRATION DATE WATER TABLE DEPTH: R-: GEOGRAPHICAL INFORMATION: Coordinates X y ❑ PERC TEST # BUILDING PERMIT# iL LAND USE APPLICATION# TYPE OF WORK: W NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER �y NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: li SEPTIC TANK TYPFJMFG 1- k r CAPACITY •~1 P"}l t CZ Bal #OF COMPARTMENTS sl.. ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL r R FOUNDATION ft PROPERTY LME ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES ❑ LEACHING CHAMBERS x #OF LINES LENGTH OF LINES F t) ft DISTANCE TO NEAREST WELL Z40 ft FOUNDATION CEJ R PROPERTY LINE 7 _ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R ^r ❑ MOUNDED WIDTH ft LENGTH It DEPTH \i DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE It y ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft c—` ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE R yS SEEPAGE PITS NUMBER �1 WIDTH ft DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION 3 O It PROPERTY LINE" it 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. �.'• MINkMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PL 'FASE CALL(209)953-7697 \ SIGNEDlz /-I I /:u• -. TITLE - ! / r T DATE [ 2. U T rI t i i , i I II �y alll � � � � llll bs.a„ ,oa.3' I ,T- ,as'{{ � o 22.0'}"e2r.0r'{ r2o2.e0'}° �° - , — ��vEr. i-9.° t i. LIN Mf� 9 �1: J F AUG 2 0 SAN JOAQUIPf COUP:lY ° a .o'.l-2a°• ENVIFONMEIJT ENT *I}27.0' 2TO' 27.0' n.0' pass' 72-338 421.0' .O' N 1{F3.LTH pEPARTM J Z0 s.O' s.O' Application Acce47te� Date— 1 Area Employee ID#FinalInspection Date:27aF-�`/�. ❑ SPECIAL PERMIT-Approved by Character of SoilV,ft: Pit/Sump Soil Character: COMMENTS PE SC Received Cheell Amount Date Permit/ Invoice# Permit ID# Code INFO By Cask Remitted Service Re oast# I 42-02-001 ONSITE WASTEWATER PERMIT 12/22/2DD3