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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT WO E MAIN STREET.STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT _CALL209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joa ADDRESS_ i l $��w AJ. t>A1(11 S 12 b _C1rv1Tw_L L_?J( r'1 S X42. <br /> CROSS STREET f—V"\ '`� APN Y�r �'".�'� ""I _PARCEL SIZE Y <br /> OWNER NAME ) ` ll ,�_ f t yYt�'t ; PHONE tP10- 1 J <br /> OWNER AnnREss I.J.+S t�y y�7��•n Nf-.I s 14� .�,��-y�...r.T-, CrrY13TATE.r ��y O t ��, �5 1"'�'Z• <br /> ri <br /> CONTRACTOR—I--t VK�,Cj)a 1`'l Lw- L�Gr��t'/Gy.,NV1�,�--• I�i"�v ii�L. PNONE,,,,W„�k r — y�..�7✓ p „_, <br /> CONTRACTOR ADDRESS Tv T " g { + s ` CiTy,'STATE1ZP <br /> LICENSE f)Ca42 QC-3S OTHER NUMBER_ EXPAATIONDATE—_ _�___..._....-._. <br /> WATER TABLE OEPTN: ft GEOGRAPHICAL INFORMATION: Coordinates X _ Y <br /> 11K PERC TEST # �, OUILOING PERMIT# _ LAND use APPLICATION till A`1 ni�d <br /> TYPE OF WORK: D NEW INSTALLATION i.? REPA iRJAoDITION o ENGINEER DESIGNEn/ALTERNATIVE <br /> G REPLACEMENT __ C3 DES;RUC'I'iON <br /> INSTALLATION WILL SERVE: C RESIOENGE 0, COMMERCIAL C OTHER <br /> NUMBER or LIVING UNITS: NUMBER or 6EORODMS' NUMBER Or EMPLOYEES: <br /> U SEPTIC TANK TYPEIMFG CAPACITY pal #OFCOMPARTMENlS —_w <br /> C1 GREASE TRAP TYPEIMrr _ CAPACITY_. gni #of COMPARTMIENTS_ <br /> DISTANCE TO NEAREST: WELL ft FCi1NDAT,ON ft PROPERTY LINE_ _ft <br /> C3 LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> C1 LEACH LINES D LEACHING CHAM6ERS __ #or LINES LENGTH OF LINES <br /> DISTANCETO NEAREST WELL ft FOUNDATION R PROPERTY LME ft <br /> O FILTERBED WIDTH N. LENGTH �.ft DEPTH ft <br /> Dt$TANCE TO NEAREST WELL–_­­ft FOUNOATION R PROPERTY LINE. R <br /> J MOUNDED WIDTH ft LENOTH,_„--, ft DEPTH ft <br /> DISTANCE TO NEAREST WELt_ ft FOUNDATION ft PROPERTY LMIE_. It "1 �¢ <br /> E3 SUMPS WI07H_ ft LENCTH_� ..____ ft DEPTHR j}~r�, p riii,j <br /> DISTANCE TO NEAREST WELL ft FOUNDATION .__...._ ft . PROPERTY LINE: ft � �•y <br /> L7 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft ` yJ�y <br /> DISTANCE TO NEAREST WELL_­ ft FOUNDATION_ R PROPERTY LINE ftA I7 2 <br /> LCI � Z•J <br /> SEEPAGE PITS NUMBER WIDTH ft DEPTHR !; �}r• <br /> DISTANCE TO NEAREST WELL _`—_. ft FOUNOATION }t PROPERTY LINE _41 <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL Be DONE IN ACCORDANCE WITH SAN JOA41AN COUNTY OROIN �'yY.ia'A�'I'v C <br /> STATE LAWS <br /> N7MU;y✓�',,t�tOUR ADVANCE�NOTICE REWIRED FOD RULES AND R NSPECTIOoNS-SAN MASCOUNTY. <br /> CALL(209)953-7097 �Y�7������T to <br /> SIGNED. l -�""` TITLE ry/V$,v L.T A^JT DATE •�1 ' <br /> 1 <br /> I � <br /> I <br /> 7 <br /> 3 - _ <br /> i <br /> ,�,�„? D P TMEergE ONLY. („ <br /> Application ccapiad Byi,r P/Data„ �f �; i�r AT89"'� Employee i(3#_',�,�1L.'..r.�.LL> <br /> Final inspect 6 Date G SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PitlSump Soil Character; <br /> COMMENTS --- — <br /> PE SC Reoeivad Ch 1d11 Amount D Ye I pew _...Invoice 0~-- Permit t0N <br /> Code INFO 6 Remitted 17 Seervice Request J# <br /> 42-77 <br /> 101007 ONSiTE'NASTEWATER T'RTMN7 SYSTEM PERMIT <br />