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I,, , ONSITE WASTEWATER TREATMENT SYSTEM PEP-MIT <br /> SAI IOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE.3"FL-STOCKTON CA 95202 - (209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATF,ISSUED <br /> Joe ADDRESS • .3fy// ,�!�ssewl .PZ� _ CITY/ZIP J'�'� 1/_ A 953 _ <br /> CROSSSTREET _ Ag1/P,PD/2/ A)A�,/ APN �o -`37�—O pARCEI.SIZEfq/4Cri�S <br /> _ �L// o <br /> OWNER NAME .i�NN �L`/GARISI�p� PHONE <br /> OWNER ADDRESS 9D.pesCO//L�.' l Pi. ._ CITY/STATFJZ[P 491 <br /> CONTRACTOR LEir <br /> PII(NIE <br /> CONTRACTOR ADDRESS N — CITY/STATE/ZIP-m/mom CA <br /> LICF.VSF. ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPLIICAi.INFORMATION: COordleateS X y <br /> ❑ PERC TEST NBUILDING PERMIT#_Q,�D—1 LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION CIREPAIR/AODITION ❑ ENGINEERDE.SIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: l RESIDENCE ❑ COMMERCIALLL ❑ OTHER <br /> NUMBEROI'LIVINGUNrrS: NUMB OFBEDROOMS: J NUMBER OF EMPLOYEES; <br /> .py SEPTIC TANK TYPE/Mf-- _ _ CAPACITY SD..C�— gal #OFCOMPARTMENTS <br /> _ Z <br /> ❑ GREASE TRAP TYPr/MFU__-__ CwrnT�" gal #OF COMPARTMENTS <br /> ❑ PIiG TX PLANT DISTANCF.TO NEAREST: WELL_ /,00 ft FOUNDATION— 7-- — ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OISEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBEAS #oI s _ LE H LINES /�jO G <br /> y _ry <br /> DISTANCE TO NEAREST WELL / /Q A FOUNDATION PROPERTY LINE_ 70 ft <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL--_R FOUNDATION ft PROPERTY LINE <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH (1 n1 <br /> DISTANCE TO NEAREST WELL R FOUNDATION' ft PROPERTY LINE ft 7 <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPni ft Jl <br /> DISTANCE TO NF.AREST WELL- ft FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH R t-ExGTH _ R DEFm It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION_ ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH —ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPFRTY LINE R � <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OP SAN JOAQUIN COUNTY. <br /> MINIMU Z4LHL1UR ADVANCE NOTICE REQUIRED FOR INSP ONS-PLEASE CALL(209)953-7697 <br /> - -SIGNED TITLE - Imre'-� <br /> TAH lOAOVIa COUHR <br /> OEPA IVEM <br /> �` ..:-t..',{('F?Q �i•9" � (y'Sl'tlt M�Y?'M1''�'2v.h�.�T"`"':.b�:� -.�,lWf�f'�" <br /> �- N � <br /> 3�r i <br /> ,4co 1?.,v <br /> fid' Txn 9,r rF �..As"•`��—� - <br /> �o - <br /> ram <br /> r <br /> DEPARTMENT US Q/N�1i Ir" <br /> Application.4cccpled Hy_._ _ .�-�-- Datc / 1(" Arca �� VF� O SSG <br /> V 55 <br /> Final inspection By Date 2 ❑ SPECIAL PERMITyd by <br /> Character of Soil to Depth of 3 Ft: P Sump Soil Character: <br /> CO M TSgVd�.. -_ <br /> PE SC Received I twwctIac AJGuunt Permit/ <br /> Code INFO B v Cash Remitted a4 Service Request Is Invoice N Permit IDN <br /> ' r <br /> 42.02.001 � ONSITE WASTEWATER PERMIT�. <br /> 12/222003 II <br />