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'Lk ;SS`fliOCIV 3J.IS : ONSITE WASTEWATER TREA'NENT SYSTEM PERMIT <br />SAN JOAQUIN Conn ENVIRONMENTAL HEALTH DEPARTMENT 600 F. MAIN STREET - STOCKTON CA 95202 - (209)468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />101 E 4,tstu <br />ØE P' <br />ctreAl c42405 <br />c3-3C2 fh7.1-ci-e_li /20 <br />JOB ADDRESS <br />CROSS STREET <br />OwNER NAME <br />OWNER ADDRESS <br />CONTRACTOR <br />Io <br />APN <br />cie-K.A...ye-- <br />46_ <br />22& — 030 PARCEL SIZE /0 <br />PHONE <br />CITY/STATE/ZIP 141 , C4 <br />PHorst LIG-6,— 3-ate 5. <br />arysTAnyzip 444-4.0 4 533 CONTRACTOR ADDRESS /3 0 if4:1 49 90 <br />CITY/Zip <br />LICENSE 1:3 C-42 C-36 OTHER <br /> <br />NUMBER <br /> <br />Oft552? EXPIRATION DATE avoz <br /> <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />iJ BUILDING PERMIT Of 1611-- 07023(1 LAND USE APPLrcATios # <br /> <br />PERC TEST 0 <br /> <br />TYPE OF WORK: NEW INSTALLATION <br /> <br />CI REPAIR/ADDITION Q ENGDIEER DESIGNED /ALTERNATIVE <br />El REPLACEMENT <br /> ID DESTRUCTION <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />CI RESIDENCE COMMERCIAL /4-ST1--4bo "4 0 OTHER <br />NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> <br />V.EACH LINES isrliEACHING CRAINIBERS <br />DISTANCE TO NEAREST WELL / 0[51 ft <br />C.1 FILTER BED Wrom ft LENGTH <br />DISTANCE TO NEAREST <br />MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />CI SUMPS WIDTH <br />CAPACITY <br />CAPACITY <br />ft FOUNDATION o f <br />0 PEG TX PLANT <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE TYPE OF PUMP <br />Sal <br /> <br /># OF COMPARTMENTS c2 <br />gal <br /> <br /># OF COMPARTMENTS <br />ft PROPERTY LINE <br /> ft <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />Igct 4944 # OF LINES q LENGTH OF LINES 0 ft <br />FOUNDATION 9 ft PROPERTY LINE .10 ft <br /> ft DEPTH ft <br />WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft LENGTH ft DEPTFi ft <br />DISPOSAL PONDS WIDTH <br />DISTANCE TO NEAREST <br />SEEPAGE PITS NUMBER <br />DISTANCE TO NEAREST <br />ft LENGTH <br />WELL <br />WIDTH <br />WELL <br />ft FOUNDATION <br />ft FOUNDATION <br /> ft PROPERTY LINE ft <br /> ft Der: H ft <br /> ft PROPERTY LINE It <br />ft DEPTH ft <br />II PROPERTY LINE ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />I 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 OF SAN JOAQUIN COUNTY. <br />MINWUM 24 HO ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />TETTE .s.r...rf-cs r* DATE 02- 07 <br />1 <br />AY <br />t-itC I D <br />A .10 E AL <br />H LTH OEP <br />SIGNED <br />g c .1.16ITY <br />-DEPARTMENT US ONLY <br />Application Accepted B <br />ate 7 <br />4-0 45. (99 <br />0 SPECIAL PERMIT - Approved by Ficukl Inspection B _ <br />Area Employee ID0 <br />Pi ump Soil Character: Ch2recter of Soil to pth of 3 Ft: <br />COMMENTS A- rk4.4_,crp-tr,ii F -7-1#) 0 FE.--T" nr- 1_074-e-t Sort_ ,Cp Lf..- 6.6 PL.-A c-F-4 <br />A- 421-1,4 i 00-2A-c- 12_,vc-r-z <br />! PE <br />Code , <br />SC <br />INFO <br />I Received <br />I By <br />460, AmounV <br />wRem <br />' Date <br />ti I ............- Per .... <br />Service Request # 11 Invoice # 1 Permit I3B0 <br />itted <br />42re 250/ /2497 .%50,.cyt) iifiyo-7 ,X 005-a0ke <br />. 1 <br />42-01 oNsrrs WASTEWATER PERMIT <br />05/30,2007 <br />A oirv /-1 o F- 1-34 E c LiAies C—A-- <br />PC-4.6 LA.LILL. S E