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ONSITE W"' TEWATER TREATMENT S` TEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEAL`T'H DEPARTMENT 304 E WEAVE -3"°FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT �u CALL(209)953-7697 FOR INSPECTIONS /EXPIRES I YEAR FROM DATE ISSUED JOB ADDRESS Ovid GG CITY/ZIP J��Ir-r�`f� GA qS y Z W11 l2 a 1.t- PK.2v�APN fy6 f ' o 3,P-Ik 6 n CROSS STREET 1 Q J ` ' PARCELQSIZzE / { r4.t�p p OWNERNAME 7tiG�C'{'OIVS Y`' TT)'I- vru.�• t{ fr�s� PHONgc�) 41 ,'"'/0 ' Iiy. OWNER ADDRESS / / • CITY/STATE/ZIP CONTRACTOR - PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# 04914 '3ff LAND USE APPLICATION# --)2- t/1 TYPE OF WORK: 40 NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ) ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER NUMBEROFLIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: Ngr'SEPTICTANK TYPE/MFG CAPACITY Z,doo gal #OF COMPARTMENTS ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LME R ❑ LIFT STATION SIZE TYPE OP PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES ❑ LEACHING CHAMBERS 0- #OFLINES )LENGTH OF LINES 6o it DISTANCE TO NEAREST WELL !J490 It FOUNDATION LO ft PROPERTY LINE ( � O ❑ FILTER BED WIDTH ft LENGTH It DEPTH R DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH R LENGTH ft DEPTH It DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft ❑ SUMP$ WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE ft SEEPAGE PITS NUMBER )�- -_WIDTH 3 R DEPTH S R DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft 1 HEREBY CERTIFY THAT I 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. MINIM M 2#HOUR A VANCE NOTICE REQUIRED FOR INSPECT INS-PLE SE CALL((2,,09)953-7697 0 SIGNED ) TITLE / 1Y ✓er- tr'lIl DATE IfP a7 RARZ r°�—� R CLAS(SR,OOMS.� CLASSROOMS ul I I P I B I;J�Jj I I51PENAIs N MIT -R �_______________� Q I :'I I BA5KETBALL J I - - nArPma i GOU2T(FJ PH 2-A N LEACH (D Y I £ IURGH BVILDIN¢ L____��__—___ ir J Io �1 HM Ir er I �}.e>- Pk-m2 ,.. Ad'I P (:W 7 PARKIN6 LOT PLAY= .00MLu 141 5 nntitN co r /rJ Lr (pd r�AEt4VIR0N1v4ENTAL wsc.NALK � y.I HEALTH DEPP.R�'3E i DEPARTMENT US O/N�L Application Accepted B Date U Area L Employee ID# Final Inspection B Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Dept of 3 Ft: Pit/Su p So/I'y�IcItr eler: COMMENTS Qs 1� S 2gr�c� .✓Z.�+If l3�ic- aliu�LEu3 - ir/ PE SC Received heck#/ Amount Date Permit/ Invoice# Permit lD# Code INFO B as Remitted Service Request# 42-02-001 �/�fa:G -�!�"'�-S ONSITE WASTEWATER PERMIT 12/22/2003