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ONSITE WA( 'EWATER TREATMENT SYc � PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALT4*K-.PARTMENT 304 E WEBERT✓E -3"°FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSCTIONS EXPIRES I YEAR FROM DATE ISSUED 1 4.. i -L.� rn JOB ADDRESS �T�_JO L CITY/ZIP kyr, .:j ` I ' y�, �� PARCEL SIZE V ' p CROSS STREET D ., APN � 7 0 OWNER NAME PHONE �13 / 2-U1 OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR _ PHONE lY r CONTRACTOR ADDRESS Ch'G`J CITY/STATE/ZIP LICENSE C-42 15C-36 OTHER NUMBER 2- EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST #, BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION REPAIWADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: / RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: ( NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ,ZrSEPTIC TANK TYPE/MFG f/�'11 1"z �� _ CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS i `` � ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL �� ft FOUNDATION SCO ft PROPERTY LINE /d0 ft 1 ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) N ❑ LEACH LINESLEACHING CHAMBERS #OF LINES_ LENGTH OF LINES O ft DISTANCE TO NEAREST WELL "O ft FOUNDATION L� ft PROPERTY LINE l<Q Z ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH \j= TJ� ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE - - ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 4 ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH SAN JOAQI Jim r QnNNi-1 ft DISTANCE TO NEAT ST WELL ft FOUNDATION ft PROPEW,YE Wb9ONMENTAI SEEPAGE PITS NUMBER WIDTH fL DEPTH I1 DEPARTMENT ft DISTANCE TO NEAREST WELL ��_ ft FOUNDATION l��'`I ft PROPERTY LINE L GO 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. MINIMI 1 24 HOUR ADVANC' CE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE DATE IL Y. r>UI d /9 41 Z i F171 T li -W L I DEPARTMENTSE NLY V 6 Application Accepted ByC�o Date Area _ Employee ID# qr4 -. Final Inspection By Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Dept of 3 Ft: Pit/Sump Soil Character:7l�G COMMENTS /�G��y� /.e��/LG/ //.rte JAplcl6 � L's 5�ri�n c�fi�� /�u�SG i 2_T�,yi�oP ��'I��J cel 7��-f•�GC.�<�/cert/.tfi-'a�,�..��z�-ill�� PE SC Received -hec- / Amount Date Permit/ Invoice# Permit ID# Code INFO By ash Remitted Se vice Re uest# VT 42-02-001 �'j/5 J(J LI/L M�( ONSITE WASTEWATER PERMIT 12/22/2003