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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3—FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE G <br /> PERMIT /CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESS 2703 W, AA L,.n1* e-w CITY-1, 4L(/J y <br /> CROSS STREET ?` H. <br /> APN PARC.F.I.SIZE Ia > <br /> o_ <br /> OWNER NAME A/y't„ L -P �v <br /> PHONE S+ <br /> OWNER ADDRESS CITY/STATE/ZIP Gl <br /> CONTRACTOR <br /> PnonL -vs <br /> CONTRACTOR ADDRESS O CRY/STATFJZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE (. <br /> WA rFR TABLE DEPTH. fl GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TV PE OF WORK: ❑ NEW INSTALLATION W REPAIR/ADnIT10N ❑ ENG. FR DESIGNED/ALTERNATIVE <br /> ❑ EPLACF.MENT _ U DESTRUCTION \) V` <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTIIER Vw(- <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBE OF EMPLOYEES:_ O <br /> ❑ SEPTIC TANK TYPE11MFG- CAPACITY 831 #OF COMPARTMENTS _ <br /> U GREASE TRAP TYPF.'MFG CAPACITY_ _ 1 #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEARFST: WELL _ ft FOUNDATION H PROPERTY LME_ _ R <br /> ❑ LIFT STATION SIZE T E OF PUMP ❑ SAND 11,SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES 8 `' <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION R PROPERTY LMT: ft <br /> FILTER BED WIDTH ft LENGT 2 fl DEPTH / ft <br /> DISTANCE,TO NEAREST WELL ft FOUNDATION R PROPERTY LINE <br /> ❑ MOUNDED WIDTH ft LENGTH_ ft DEPTH ft I <br /> DISTANCE TO NEAREST wEI 1. ft FOUNDATION R PROPERTY LINE It <br /> ❑ SUMPS WIDTH_ HLENGTH R DEPTH it <br /> LT, <br /> DISTANCE TO NEAREST WEft UNDATI ft PROPFRTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH_ R DEPTH ft r <br /> DISTANCE TO NEAREST WELL ft FOU TION ft PROPERTY LINE _ (( <br /> C3 SEEPAGE PITS NUMBER WIDTH ft DEPTH_ R <br /> DISTANCE TO NEA REST WELL fl FO NDAT N R PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE.PREPARED THIS APPLICATION AND T ,WORK WIL BE DONE IN ACCORDANCE WITII SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES A RECULATIO OF SAN JOAQUIN COUNTY. <br /> MI IMUM 24 HOUR ADVANCE NOTICE Rk:Qla D FOR 1ti5PF.CT'1 NS-PI,EASF.CALL(209)953-769i <br /> SIGNED TITLE .7/' DATE <br /> 1 <br /> Y <br /> 1,ff2j 44-- <br /> I <br /> 20 <br /> N 1 DE A <br /> 41 EPARTMENT C. ON <br /> Final <br /> Application Accepted BY Date Area Employee ID# <br /> Find Inspection By_ Date ❑ SPECIAL PERMIT-Approved by r/ <br /> Character of Soil to D7bjof 3 Ft: Pit/S mp Soil Ch rocter: <br /> COMMENTS <br /> zo <br /> E SC Received �Cb / Amount Date Permit/ Invoice# PermI11D# <br /> Code INFO B Cath Remitted Scrvltc Re De3t q <br /> (04 61 if I ` 4g & 11µ1 ��oo <br /> 42-112,001 <br /> 1222/2003 ONSITE WASTEWATER PERMIT <br />