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am ONSITE ,'STEWATER TREATMENT SYSTEM ZMIT <br /> SAN JDACIUIN COUNTY ENVIRONMENTAL,HEAD.n DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)458.3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES T YEAR FROM DATE ISSUED <br /> JOB ADDRESS 604 AVORfH c}4 a A CrTYr4P Sr CICT—OBJgSZ(Z <br /> > CROSS STREET SH if FEE Lv- APN O e 5✓xD�+3� PARCEL SIZE Z>a/ g <br /> OWKERNAMS -MA5. 1b-IUMA2 rte{oo,Q 5�"dGiCTOrJ PHONE477 <br /> OWKERADDRESS5gO4 N' ti`—DOR-AP0l SU Ir. D CRYISTATEam w <br /> CONTRACTOR_CH E5 A1,E -GOnI S U C-7T-(&j 6 PPHONE—."9-1402 ^ <br /> CONTRACTOR ADDRESS O • BV;K 3/ I4- „---,,. CITY/STATEIZIP Tulz L,0Q&, r A 9L79?/ <br /> LICENSE ❑C-42 ❑C-36 OTHER NuMBER EIPIRATION DATE <br /> WATER TABLE DEPTH: 5'9 t, ft GEOGRAPHICAL INFORMATION; CoordinateS X Y <br /> I�PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# —0 D[Q <br /> TYPE OF WORK 13 -4 NEW INSTALLATION ❑ REPAIRIADOITION ❑ ENGINEER DESIGNED!ALTERNATIVE <br /> I D REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 1 <br /> 0 SEPTICTANK TYPE/MFG CAPACITY <br /> Dal #OF COMPARTMENTS <br /> O -GREASETRAP - TYPEIMFG CAPACITY 931 #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LINE ft <br /> Q LIFTSTATION SITS TYPEOFPUMP O PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES ❑ LEACHING CHAMBERS IfOFLINES LENGTHOFLINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft to <br /> O FILTER BED WuTrH It LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTYLINE fl <br /> 0 MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UN£ ft <br /> E3 SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION <br /> It PROPERTY LINE it <br /> O DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft T <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> d SEEPAGE PITS Numam WIDTH ft DEPTH_ft <br /> k DISTANCE To NEAREST WELL ft FOUNDATION ft. PROPFRTYLINE ft <br /> y I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCOR13ANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> ISTATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPEFCTIMS-PLEASE CALL(209)933-7697 <br /> SIGNED TITLE 0M✓� DATE S-Z -00 <br /> IV <br /> E <br /> NO I <br /> I'll E <br /> - - DEPARTMENT US ONL -- - - " - - <br /> ApplicationAxeptad / Date .rL �4 p� Area Employee ID# <br /> Final IOape Cn B Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to EWJA of 3 Ft. Pftump Son Character: <br /> 1 <br /> PE SC ReceivedChaC Amount Permit/ <br /> I Code INFO 8 s emitted Date Sarvlce Uest* Involce# Permit 1D# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 10141D7 <br />