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/V <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUN'rY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE. -3Y0 FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> 7- n <br /> JOB ADDRESS ✓c F t 4L ` v7 CITI'/ZIP S�C ��� C� % Z <br /> I� <br /> CROSS STREET `/_' <br /> •'"' I �'� SG r(Y'la 1 Lt W1 M u• _u M APN 0 •aZ c J PARCEL SIZE v <br /> OWNER NAME. ?[�' ,2 r- 'A I,L�` PHONE/ ZtJ9� /L' <br /> 1 y <br /> OWNER ADDRESS S ] OU NL i �) / C C CITY/STATE/ZIP 5j'4(F`*i j C)+ 7G 121 Z <br /> CONTRACTOR PHONE: <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER _ EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> L3 PERC TEST N BUILDING PERMIT# `�D 3�j At _ LAND USE APPLICATION# c P C5 S.� <br /> TYPE OF WORK: JK NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/AI-TERNATIVE <br /> ❑ REPLACEMENT 1� ❑ DF.STRUCt-ION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE Ys COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG CC C _Q CAPACITY Z F O V O gal #OF COMPARTMENIS 2- <br /> Q <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WEI.L- 1 R FOUNDATION _ R PROPERTY LINE 5-- R <br /> ❑ LIFT STATION SIZE TYPE Or•PUMP ❑ SAND OIL SEPARATOR(ENCLOSED(SjY•S�TEM) <br /> LEACH LINES L1 LEACHING CHAMBERS Z #OF LINES LENGTH OF LINES J (J R <br /> DISTANCE To NEAREST WLLL AMC It FOUNDATION 3C) R PROPERTY LINE R <br /> ❑ FILTER BED WIDTH _II LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL, R FOUNDATION R PROPERTY LINE It <br /> ❑ MOUNDED WIDTII R LENGTH h DEPTH R <br /> DISTANCE TO NEAREST WE.I.I. R FOUNDATION R PROPERTY LINE R <br /> Cl SUMPS WIDTH ft LFNGIH 11 DEP Iit R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WID'T'H R LENGTH R DEPTH (t <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> SEEPAGE PITS NUMBERWIDTH _ 3 R DEPTH Z S R <br /> DISTANCE TO NEAREST W'F.L1.�(Q— ft FOIINDAI ION � � __ft PROPERTY LINE �7 R <br /> 1 HEREBY C'E:RTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN C'OUNTI' <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> N11N NIU 124 HOUR ADVANCE.NOTICE:REQUIRED FOR INSI E' TIONS-PI. ASF.GALT.i'_O41 951-7097 / <br /> Sl(:NF.D _ I'• / /. IA /.av _ TITI.EV�dtt..� DATE ZZ <br /> —110.9 <br /> � I IIIHII�I JI I �. <br /> 4 e <br /> kc- 3 L---------- <br /> } <br /> 186.3' <br /> Tt <br /> 13 <br /> I <br /> +I91- 22.0-,H 22.0•}{22.0"{- <br /> 7rr�rrrrfro �� � <br /> ,,�,-,o• � SPIncNn <br /> n <br /> + SAN JOAQUIN 1 <br /> 0 <br /> ENVIROWE <br /> a zo.o{ 21s.o NINTH DEPA' <br /> 27.0 2q0, 27.0' 27.0' ou-D•—# 72.0' <br /> I 12.5' <br /> }--33.8' 2 1.0' n 7 0 50' <br /> 0' <br /> 0 c <br /> Application Accepted B <br /> Date Z'Z Area Employee ID# t <br /> Final Inspection By Dale _ _ __ ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Dept1`3 Ft: Pit/Sump Soil Character: <br /> � , l%✓•3C,�/!i C!-' <br /> COMMENTS AVIL Clro-1 S6,,z <br /> X1`1 "k 3S 3� /X�" e�i»,ti� CACI <br /> Sc":lC iC <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Remitted Service Request# <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />