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I 'ONSITE WASTEWATER TREAT-MEN7'SYSTEM PERMIT SAN'JOAQUIN COL NTS"F.NVIRONMf:NFAI IIf:AL'1'N DEPARTMENT 304 E WEBER AVE-3""FL-STOCKTON CA 95202 -(209)468-3420 IV NON—REFUNDABL /E PERMIT 1 CALL(2097),953-7697 FOR I%SPECiION:S EXPIRES l Y AR FROM DATE ISSUED JOB ADDRESS ! O(I) W_ (`L-Aj E-0 S"C"' M-EN1 ��) CITv/Ll'r1 _ ,-��"� ) �R W�(^}' APN ll (USI L10—II PARCELSI7.E D.�� - CROSS STREET V '` r \ �/ -- {//I PHONEV OWNER NAME (/�S} ,]� l/l; (�'l�JL OWNLR ADORES app W��IO/ 0 �C- + 1 )*;t SSATFJLIP CONTRACTOR 'O /✓� ___ _ PHONE _ _- CONTRACTOR ADDRESS`--T) LICENSE U C-42 ❑C•36 ()TREK NUMBER EXPIRATION DATE YY'ATERTABLEDEPIII: ftGEOt:RAY CALINFORMATION: Coordinates X Y ❑ PERC TEST B BUILDING PERMIT# _ LAND usL APPLICATION# _ TYPE OF WORK: O NEW INSTALLATION ❑ REPAIR/ADDITION U ENGINEER DFSIGNFD/ALTERNATIVE El REPLACEMENT DESTRUC'EION INSTALLATION WILL SERVE: ❑ RESIDFNCF. ❑ COMMERCIAL ❑ OTHFR__._,_ Ni.mork OF LIVING UNITS: NLMRF.R OF HEDROoms: NUMBER OF EMPI.OY'F.FS:_ U SFP-ITC TANK TYPFJMFG CAPACITY f`� ❑ GREASE'h RAP TYPE/MFG CAPACIIY gal k Oh'COMPARTMENTS Ve mml may hale ex�i�pri without ❑ PKC TX PLANT DISTANCE to NEAREST: WELL � R FOUNDATION 11 PROPER Y N R " r PP n r��p��Qt �{ nr'nC�P��p ❑ LIFT STATION 517.F._ TYpEOFP11Y1P ti 1 A�'b��H.SEPAi(a`Y'OR,(EhL�tdtEb`SCSYY.II� ❑ LEACH LINES ❑ LEACHING CHAMBERS ft,)i-LISES LENGTH of EWES ft DISTANCE TO NFARF_ST WELL It FOUNDATION ft PROPERTY LINE ❑ FILTER BED w1uTD ft I.FNGTH it DEP'rll DISI ANCE TO NEAREST WELL. _ft FOUNDATION _ _ R PROPERTY I.INF R I ❑ MOUNDED WIDTH ft LENGTH R DEPTH -- _- - ft bl b DISTANCE TO NEARESF WELL _ ft FUCNDAnOS _ R PROPERTY LINE ft ❑ SUMPS Wit) H R LENGTH ft DEPTH DISTANCE IO NEAREST WEL1_ R FOUNDATION R PROPERTY LINE tl IV ❑ DISPOSAL PONDS WIDTH R. LENGTH_ _ R DEPTH D151'ANCETONFARF.ST WELL _ ft FOLINDATION _ --ft PROPERTY LIVE 1[ 1y! ❑ SEEPAGE PITS NCMRFRWIDTH _--_R DEPTH ft 1 ' DISTANCE to NEAREST WELL ft EUUNU.AIION R PROPERTY LINE R I HEREBY CFKI IFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE"I I H SAN JOAQUIN COUNTY ORDINANCFS,STATE.LAWS AND RULES AND REGULATIONS OF SAN JOAQt:1N COUNTY. {Il^ MINIMUMV 24HOL ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PI,F,ASF.CAIA.(209)953-7697 SIGNED�T 6.�� _ TITLE w DATE U t �J %X z F S E `3 .N) � y g InD, � 16T F RECEIVED , AUG 16 2004 .p n SAN JOAQUIN COUNTY .J ENVIRONMENTAL 0.J HEALTH DEPARTMENT -1 [-- Ll- - — h .F SLY---�� ^ DEPnRTME T U O APPIk■tion Accepted By Date eI(G f 0 Area Lmployce IDp Final Inspecliun Bv Date ❑ SPECIAL PERMIT-Appr—ed by /- Character of Soil to Depth ol3 Ft: PiVSump Soil Churacter: ;COMMENTS 9il zr .zxs3g7il�� PE SC Rectived Che / Amount Ptrmit/ Code INFO RY ash Remitted Dat` Servke R lest k lm'uicc k Permit IDk 41.24 o-7s -J 1b D �Do39Z � 42-02 001" 7- /, - (iC��) �- � ��1 C ?"�� ONSITE.WASTEWATER PERMIT 12!222003 _ -