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� 2tg e-a ® ONSITE W JEWATER TREATMENT SN" TEM PERMLT S&%JQAQMN COUNTY ENVIRONMENTAL HEA*DEPARTMENT 304 E WES.WAVE -3'a FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PER,/IT CALL(209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS '7 �1 �E"� (/Fn"' CITY/ZIP G oD/ CROSS STREET APN 67 :7r, ' 1 PARCELSIZE /,)-�Z Ae+ 9 n�,4 e OWNER NAME �-�f t r"I ) P is I�'e[�Qt- I r\C C140,4-0 PHONE 339 - -7-s33 s 33 OWNER ADDRESS CITY(STATE/ZIP CONTRACTOR PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: �i�� ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT jT DESTRUCTION n 1r T INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER r� (� NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG� L' CAPACITY /719,13 gal #OF COMPARTMENTS .2 /❑_ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS G.. ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LME R ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES ❑ LEACHING CHAMBERS #OF LINES J LENGTH OF LINES /00 ft DISTANCE TO NEAREST WELL /'O0 ft FOUNDATION S--0 R PROPERTY LINE R ❑ FILTER BED WIDTH R LENGTH R DEPTH it DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH R DEPrH R 11 DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft �Lj SUMPS WIDTH .2Z ft LENGTH 6r, R DEPTH //,) R / ` DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LME R ❑ DISPOSAL PONDS WIDTH R LENGTR` ,. DEPTH R DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LME R ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LME R 1 HEREBY CERTIFY THAT 1 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. \] M2,m4um OUR ADVANCE NOTICE REQUIRED FOR INSPEC�TL NS-PLEASE CALL((2209)953-7697 SIGNED / - / TITLE !�/f5 / Cy/d'`C117� DATE a7 G 129 i 9y, Rk" 1. ,�\ .. ✓ern � ♦moi �.yi! a LG Z FE2,4 1iFe ♦ ' lit gg 1" B.Pwrscmoti '" g !o f1< THIS PERMIT Iu. Soo y.i i / \* S': ..:P p RT TER P & •� i Fx r DEPARTMENTU ON Application Accepted B — Date Z 0 Arco EmployeeIDB Final Inspection B r Date ❑ SPECIAL PERMIT-Approved by Character of SoH to Dep of 3 Pt: Pit/ ump 11 Character: COMMENTS C S PE SC Received hec Amount ate Parrott/ Invoice# Permit lD# Code INFO ash Remitted Service R uest k PTV I 4T&P 1 3 S'o 4 zn2/2003 �°Gyl/ GclJ o s w �.�'7�.s4-t�7 ed-�3Cexel�it�