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ONS WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIR NT` .I'ALTH DEPARTMENT 304 E WEBER AVE-3-FL-STOCKTON CA 95202 -(209)468-3420 NON-REFUNDABLE PE IT JJ CALL 209 I 953-7697 FOR NSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS Z ' M9 IS QTJ CITY/ZIP Lo D I LA CROSS STREET I 'I MA O+ APN /LI(3 ^ 0 C 3 r ��J PARRCCEL SIIZEE /"1 C� O OWNER NAMF. �S—C^I'NI��^I� �rl�l`y,� pQ�C LOO `0!^ 3b 1�Ob( OWNER ADDRESS 2100 N,``dJ011 IS t�M CITY/STATE/ZIP `OO 4 IE CONTRACTOR SC 6 WWE2 -&P1 `r`� S0'J PHONE '2(5 y')�J �� ^O(f;^ CONTRACTOR ADDRESS 1-1 S Oa CITV/STATE/ZIP '!1 LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE 0 WATER TABLE DEPTH: 0 GEOGRAPHICAL INFORMATION: Coordinates X Y ? ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: O NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: —� SEPTIC TANK TYPE/MFG COaLRE - CAPACITY 12oO gal #OF COMPARTMENTS 6 N, ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS r+ ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LME ft fo ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES 1.. J� ft DISTANCE TO NEAREST WELL 14 O f -it FOUNDATION ft PROPERTY LINE e�30J ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft N DISTANCE TO NEAREST WELL ft FOUNDATION H PROPERTY LINE R ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R _0 SUMPS k WIDTH�-1 ft LENGTH 1qL ft DEPTH 1_6' M R WELL DISTANCE TO NEAREST `1 It FOUNDATION ft PROPERTY LINE �W ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL. H FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNLID-:� TITLE"'--5:-,, DATE f LA i I I O 0 ZENO AN E �s .- .- DEPARTMENT IISE O�A,I' Application Accepted By 'lJ Date 2-11(,�t U"L Area Employee Final Inspection By or Date c 7-�ob� ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth o 3 Ft: Pit/Sump Soil Character: COMMENTS U(A'T 0 F S£/�v/G£ S£aT C rtjJ>° -GT?TJ'j IT-S' a„Et.SE f3 S- .3 TFC=r rJ1_C 02ic.,cLC PC,"e- S7E� �cIr QS-C'S� at-�/2 -3 /L�i'D - �E�ccv/-vG MC$iLE �pucE PE SC Received Chec Amount Date Per-it/ Invo'e# P r t Code INFO B ash Remitted Service Request# 4 i Cris- �cs \ 0-2a 42-02-001 lQ , Q �G_✓�rC izrzvzoo3oC��_ C� J�..,'7j