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IiI-P <br /> ONSITE WA 'EWATER TREATMENT SYS EM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALT1weH DEPARTMENT 304 E WEBER"TVE -3"°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE�PERMIT GECALL 20090 _T953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 'li1,J� N r T GnnPW DR. CITY/ZIP 5-roL. ON X15 ws � <br /> CROSS STREET �(�/^J►GtWPtt� - 9'. A <br /> APN !/�2 —44!/Q PARCEL Slze x a <br /> 0 <br /> OWNER NAME 151KN 1_30kQ%A1TwEI�CTR� '(� PHONE <br /> y <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR OR.T QT1G 17r1 �Li IrJCr PHONE <br /> CONTRACTOR ADDRESS ZOA T_t.D -Ar— CITY/STATE/ZIP LO t 4R ?-40 <br /> LICENSE A C42 ❑C-36 OTHER NUMBER '7'5dl 1514 S EXPIRATION DATE C)?-( O <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# DSU 3fbS3 LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: n u NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ;� <br /> ® SEPTIC TANK TYPE/MFG � G.tn-�7T CAPACITY �O D O gal #OF COMPARTMENTS Z <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION r ft PROPERTY LME Go' ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I n <br /> ❑ LEACH LINES Nt LEACHING CHAMBERS #OF LINES 39 LENGTH OF LINES 45 ft <br /> C DISTANCE TO NEAREST WELL - ft FOUNDATION ft PROPERTY LINE ' ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> In DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> P ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> t1 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Iv ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> _a DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> N A SEEPAGE PITS NUMBER � WIDTH 3� t 1 y w ft DEPTH -L'51 ft <br /> 0 DISTANCE TO NEAREST WELL t R FOUNDATION '0 1 ft PROPERTY LINE S ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED L TITLE DATE 0zL310(- <br /> 2W - - - <br /> f e- <br /> y G <br /> 6 125' <br /> y it \ <br /> 75' <br /> �.. <br /> M <br /> TV.) <br /> t0 ' <br /> EPARTMENT SE O LY <br /> Application Accepted Date 2 Area Employee ID# <br /> Final Inspection Ap Date_ f ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth f 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS?j�%1.arlf��/ <br /> /�ij�/u�.✓G��>.�'��YJ6 -�Cc�7/1fL�+21fflllc f� G��-''G<7cl�i'-�r�r!�/(�/h�✓/�Q��-xY�t�-fG <br /> PE Sc Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Remitted Service Request# i <br /> Z6-- 3 <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />