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ONSITE WASTEWATER TREATMENT SYSTEM PERMI /�{�/ <br /> SANJOAQUIN- ,- [Rg!�NIENTA_L.HEALTHDEPAR'fMENI� /�,/7 /j.U4 EWEBERAv'L-3`°FL-S'IOCKISPr O <br /> NON-REFI �,� � 9zi� �i j 9)9 6 0K f�st'E"�r10NS EXPIP <br /> CS 1 YEAR FROM DATE ISSUED <br /> JOA ADDRF_SS - -- --" CIT'(/.IP <br /> CROSS STREET _ ►7�J /�1}.�� -s -0— <br /> APN U /7 GI- I Lf O Z.0 PARCELSIZE �Z-•12'/[LC• <br /> Ny <br /> ' <br /> O <br /> NER NAME �`" J �"� V-U'�1Y�'/1^`�,•1 1 1/�� p `.},,,• Pll_ONF.._ '(7J--7 <br /> 0%NF.R ADDRESS �� CS`L-J �/ V�• -� '•'\ �! rlr„TATE/LIP f •• <br /> ✓ _, ? <br /> CONTRACTOR <br /> CONTRA(TORADDRESS CFFYt1�FATFILIP <br /> LICENSE U C-42 ❑C-36 .01HER NUMBER ExPIRATION DATE <br /> WATER T.ABI.E DEvFH: 11 GEOGRAPHICAL IN1 0kMATION: Coordinate., , X Y' <br /> ❑ PERC TEST # _ BL'1LDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ YEW INSTALLATION U REPAIRIADDITION ❑ ENCINF.F.R DF.SICNED 1ALTERSATIVF. <br /> ❑ REPLACEMENT DFCTRU(TIO\ SL <br /> INSTALLATION WILL SERVE:' ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER tite^ r <br /> NUMSEROF LI>.'ING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: *\ <br /> ❑ SEPTICTANK TY*PF/MFG_ CAPACITY - .. gat NUFCUMPARTMENIS <br /> ❑ CREASE.TRAP TTPEMFO CAPACITY gal #OF COMPARTMENTS <br /> f/3 PKC TX PLANT DISTANCETONEAREST': WELL fl FOUNDATION It PROPERTY LINE ft <br /> lL.l IJFFSTATION SILL TYPF.OFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACH INC CHAMBERS #oFLINES LENGTH OF LINES H <br /> DISIANCETo NEAREST WELL fl FOUNDATION F1 PROPERTY LINE _ _ ft <br /> ❑ FILTER BED WIDTH _ tl LENc;TH ft DEPTH_ tl <br /> DISTANCF.TO NEAREST WELL ft FOUNDATION _-_ H PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH R LFSC,,TH _ ft DEPTH It <br /> DISTANCE TO NEAREST WE[1. _ it FOUNDA HON ft PROPFRTY I INF fl <br /> ❑ SUMPS WIDTH ft LENGTH_ �ft DEPTH -----_-- _ ft <br /> DISTANCE To NFARFST WELL ft FOUNDATION R PROPERTY LINT <br /> ❑ DISPOSAL PONDS WIDTH B LhNUI'H ft DEPTH (t <br /> DIYFANCE TO NEAREST WELL Il FOUNDATION It PROPERTY LINE ft <br /> ❑ SEr.PACEPas NUMBER WIDTHft DFPTH <br /> DISTANCE.TO NEAREST WELL __H FOI:NDATION_- _fl PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I IIAN'E PREPARED THIS APPLICATION AND THE WORK WILL.BF:DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HO ADVANCE NO.1"ICE REQUIRED FOR INSPECTIONS-P.EASF.CAIA.(209)953-7697 <br /> SIGNED TITLE. DATE <br /> e _ <br /> i <br /> T1 <br /> _ tt a4 39. FE—; \ o <br /> y ¢� L <br /> �l•--� o is r/ 3 dr ro O <br /> 75�k1-7 T�d <br /> � lcnN4KIIli9.tYs?ic(i — <br /> 1 awe. 4i7tilc AYMENT <br /> v _DECEIVED <br /> � 2004 <br /> %..�_. _ � :J SAN JOAOUIN COCHJTY <br /> r-'--�' -^tet-- - -�- ''-•S�Oij•-"'ENVIRONMENTAL <br /> `�' HFjU.TH D>=PAH11lEFlti _ <br /> DEPARTMENTll, O 1' <br /> Application Accepted By 1�S/a Dale I �C .Area F.mplo,� ILNI 01` <br /> 17 <br /> Final Inspection By C" Datc J—7h'C.I _ ❑ SPECIAL WERMIT-Appmvrd by <br /> Character of Soil to Dep of 3 Ft:_ _ Pi1)Sunlp Soil Character: <br /> COMMENTS - <br /> PE SC Received Ch .1nlount Date Permit/ Invoice# Peradf IDN <br /> Code INFD B Cash Remitted Service Re uest# <br /> �z.zi ms 59.C%D FYI O?n 2 Ell <br /> _ 42-02-001 ,v,•,.J.- _ 4.� — - __STEWATER PERMIT ` <br /> 12,22'2003 �` ' <br />