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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 304 E SAN JOAQUIN COUNTY ENVIRONMENTAL HEA TH DEPARTMENT WEBER AVE-3"FL-STOCKTON CA 95202 -(209)468-3420 NON-REFUNDABLE PERMIT (3 f CALL 209 953=7697-FOR INSPECTIONS ' ' ' /EXPIRES 1 YEAR FROM DATE ISSUED l-4.rl_n b -Rd - _ CITY/ZIP JOB ADDRESS 1(Y �Jy qt1 CROSS STREET ��M /a I�/Y `y[J APN r &I t7 2-— 46 , o CJ/tVal/ �Q�Ip�L PHONE �09-5/6L /uory OWNER NAME /J )�� p iv OWNER ADDRESS �I 3 W I' ��B n d CITY/STAT'E/ZIP CONTRACTOR M1/ - )(.( PHONE ) CONTRACTOR ADDRESS .) CrrY/STATE/ZIP i LICENSE ❑C-42 ❑C-36 OTHER "I NUMBER EXPIRATION DATE WATER TABLE DEPTH: 1 R GEOGRAPHICALINFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# / Z-LAND USE APPLICATION# ' TYPE OF WORK: W NEW INSTALLATION 13REPAIR/ADDITION C3 ENGINEER DESIGNED)ALTERNATIVE Ll REPLACEMENT - 1. ❑ DESTRUCTION - INSTALLATION WILL SERVE: kESIDENCE ❑ COMMERCIAL •❑ OTHER NUMBER OF LIVING UNITS:I• �,1I' rt-p NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES:SEPTIC TANK'� TYPFJMFG 1¢- 1 OD CAPACITY -000 gal #OF COMPARTMENTS GREASE TRAP IYPF/MFG yIL CAPACITY gal #OF COMPARTMENTS ❑ PKC TX PLANT DISTANCE To NEAREST: WELL R' "FOUNDATION R PROPERTY LME ft ❑ LIFT STATION SIZE I - TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) y� LEACH LINES >(LEACHING C IHAMBERS #OF LINES LENGTH OF LINES ft { , DISTANCE To N EAggEST WELL ft FOUNDATION R PROPERTY LINE ft i ❑ FILTER BED WIDTH d it LENGTH ft DEPTH ft j DISTANCE TO NEAREST WELL ft FOUNDATION / R PROPERTY LINE R .� ❑ MOUNDED - WIDTH I - It LENGTH fl DEPTH ft n DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH Q R LENGTH ft DEPTH fl DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE It L) DISPOSAL PONDS WIDTH I I ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION it - PROPERTY LINE ft ❑ SEEPAGE PITS NUMBERIDTx ft DEPTH R iDISTANCETO NEAREST WELL it FOUNDATION R PROPERTY LINE R I i I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY -,WF- - /..cAN a0GAOl11N C^OUNTV. M 9 Rp SIGNED t tr- i — _ _ --��- -- —_ Ivor wo•E% _ a-n 1740 PYRN2D I NaNE'DEI1J IS cxa� Fie CEIT VE o MAY-2 5 SAN JOAQUIN COUN7y — _ EN1/IRONMENT� _�N — _\ \• DEP �0 130 ZO — I Application Accepted By - - Date Area Employee ID# p cis Find Inspection By i• Date `% ;r-L5?� .❑ SPECIAL PERMIT-Approved by v I Character or Soil to Depth of 3 Ft: PltlSump Soil Character: l COMMENTS OL-0 L- 7 El PE SCReceivtd Amount Date Perm1U ` Invoice# Permit ID# I Code INFO B Cash -Remitted Service R uest#• - 125 17 1 \ T 42-02-001 ivtCYC �'� in 9 �Da-' fa t"��' w2fP. S� ��y�� E?ePISITE WASTEWATER PERMIT j. I2rz212003 -�./huFr.-r z�rcc� '. f3s sc� 5/o C6 l nn- •urc�! d� ro %c�c/r<��/ ��O""eI