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ONSITE WAS" WATER TREATMENT SYST' M PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH Dft_KRTM ENT 304 E WEBER Ave-3"'FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS E�XP,IIR`E�S I YEAR FROM DATE ISSUED JOB ADDRESS / /!JO b✓ 5"!� VAL-Pie& �© ICIITTYIZIP 7—R 4,e, 95 37�7 m y ^`�I �"/"r PARCELSIZE CROSS STREET Al/�J�ALp�q^L�yL O("W ae..�.r, �^ APN�s OWNERNAME Sr P�RAoA�b(5 / M/Yl OG1C L.�4(,ee1V PHONE OWNERADDRESS CITY/STATE/ZIP CONTRACTORC LSC C- CONTRACTOR — PHONE. !�!r/�s,Y,/",l.Yf'✓/j�,r�/� CONTRACTOR ADDRESS O " Q X 7/4 CITY/STATE/ZIP: /T LICENSE LI C-42 E3 C-36 OTHER NUMBER E%PIRATION DATE rti WATER TABLE DEPTH: w ft GEOGRAPHICAL INFORMATION: Coordinates X Y O FL7PERC TEST(S) NUMBER LAND USE APPLICATION# P aFG JAWEE TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPMR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER - NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS C ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS -'l1 ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION fl PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) Q ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES R DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH H DEPTH Rn`� DISTANCE To NEAREST WELL ft FOUNDATION R PROPERTY LINE R 7� ❑ MOUNDED WIDTH R LENGTH R DEPTH R DISTANCE To NEAREST WELL ft FOUNDATION R PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH R DISTANCE To NEAREST WELL ft FOUNDATION R PROPERTY LINE ft ❑ SEEPAGE PITS WIDTH R LENGTH ft DEPTH ft 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. MI HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS--PLEASE CALL(209)953-7697 SIGNED TITLE okilhlcrt DATE 9- AN I J NV N I fAl I 4 I - t -- -- DEPARTMENT USE NLY — — --- - --- - - - - Application Accepted ByDateWit/Sump Area Employee ID#�y9 S/p� Final Inspection By Date El SPECIAL PERMIT-Approved by Character of Soll pth Ft: Soil Character: COMMENTS .. ✓ O'/ PE SC Received / Amount Date Permit/ Invoice# Permit ID# Code INFO By, ash Remitted Service Request# S2 ► 93 5200 35/35- 42-01-001 12/2/02 ONSITE WASTEWATER PERMIT