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2 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRCKMEWAL HE'ALT14 DEPARTMENT 600 E MART STREET-STOCKTON CA 95202-(209)4693620 <br /> NON-REFUNDABLE PERMIT CALL 209 963-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> ice ADDRESS Z S 3 I e� #j. `f M A j j-r D IJ 9-b . CiTYrzv -►�1 T�1�.7 L� <br /> CROSS STREET <br /> 'F -+"� APN ty,- %3.(:).-C)4 PARCEL SIZE be <br /> OWNER NAME 1�QN 1cL-�-P wt E,(Z t7 p,11w 46-1 -9039 <br /> Ova"ADDRESS Z- •�a W. ?eL,xl F-T`r7 F-7 CRYfSTATETP <br /> ` CONTRACTOR WJE O t%yh o L.N�1iE-off . IN I— PHONE 3tY. -03�'5' �\ <br /> CONTRACTOR ADDRESS •o-�- of. ClMac w` S-T . CITYfSTATEI71P L-0-C) 1 C-A <br /> LICENSE QC-42 OC-3s OTHER_ NUMBER EXPIRATTOHDATE W <br /> W <br /> WATER TABLE DETrTN: R GEOGRAPHICAL INFORMATIaV: Coordinates X Y <br /> PERC TEST i__._. ._- F BUILDING PERMIT# ---__ LAND USE APPLICATION 11111_ ^ ._ Z <br /> TYPE OF WORK: n NEW INSTALLATION ❑ REPAIR ADDHIOf1 ❑ F14GINEER DEE1tiNEII lALTERNATTVE <br /> REPLACEMENT ❑ DESTRUCTION t <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUNEER OF UVING UNITS NUMBER of BEDROOMS' NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE Mrd -- CAPACITY___ pal MOFCOMPARTMENTS <br /> ❑ GREASETRAP TYPFJMFG -------- GLPACTIY ------ gal MOFCONIPARrMENTS------ <br /> DISTANCE TO NEAREST: WELL ._-_ ft FOUNDATION- __-- ft PROPERTY UNE --It <br /> Q LIFT STATION SIZE_ TYPE OF PUMP 0 PKG TX PLANT O SANDOIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES 0 LEACHING CHAMBERS MOF LINES LENGTH OF UoEe-- <br /> fi <br /> DISTANCE TO NEAREST WELL —It FOUNDATNON– ft PROPERTY LIE It a <br /> ❑ FILTER BED Vtmm --It LENGTH---.--�----`--fl DFPrH_-- --It <br /> DISTANCE TO NEAREST WELL__ ft FOUNDATION_ ft PROPERTY LEE —it <br /> ❑ MOUNDED WBTN_-- ---tt LEPIGTH--^ -__A DEPTH--- _ It <br /> 0197ANCETOMEARCST WELL It FOUNDATION _ft PROPERTYLME_ --It <br /> f ❑ sumps Wcm_�- It LFHMM -- fl DEPTH-- -_ft <br /> DIStANCETO NEAREST 'WELL__ft FOUNDATION-- R PROPERTYLFE _It <br /> ❑ DISPOSAL PONDS Wv1N ft LFNGTH,__- �_ - R DEP rH _n <br /> DISTANCETONEAREST WELL ft FOUNDATION fl PROPERIYLNE _-_h <br /> ❑ SEEPAGE PITS NUMBER WvTN-- -- ft DEPTH--- _-- _ft <br /> OISTANCE TO NEAREST WELL — tt FOUNDATION– it PROPERTYL►.E_ _fl <br /> I HEREBY CERTIFY THAT I HAVE PREPARED T103 APPLICATION AND THE WORK WILL Of DONE RV ACCORDANCE WITH SAN JOAQUIN COUNTY DRDNNANCES, <br /> 97ATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MB/MU HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 1 <br /> SIGNED TITLE .G9rJj\'LT�'CT-'� DATE S-Itp-It <br /> +.•fbi-? +TYI'aryES'" an.?)g`v"-f+G'�pF'tid;+1.'t'CI xT?€t �=sr -'+J'e"�+'c,p v�, _ _ .. <br /> DAY <br /> MENT <br /> r t <br /> �Fg-- : , AY 2 0 2011 <br /> 1 I JOAOUIN COUNTY <br /> NV1R0 PARTNIENT <br /> 1 �D <br /> ------------- <br /> I y r ®OP <br /> DEPAR7MFJNT�13 ON,4Y <br /> Application Accept* _ _ - <br /> Final Inspection By '� Date -_ O SPECIAL F) RMR-Approved by <br /> Character of Soil to of J Ft: P ump Soil Character. <br /> 3S �, <br /> COMMENTS <br /> IPE SC Revolved Ch AmouTrt - � w - Invoice i Permit IDE <br /> ode iNF 6 Cash Remitted D rviv-.,-.,....t e• J <br /> D IS 112-7-�� I -.:0 <br /> t ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 42-01 <br /> 101477 <br />