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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQIIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3"'FL-STOC'KTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECT 10NS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 1'� �� , KI c k J CITY/ZIP J, II II J CROSS STREET J4/�i}I\t 11,C L{ J� APNI 2_1 PARCEI,SI%F. OWNER NAME. `� �71 1 I I�C�l�i(�I�-I ��I PIIONF. {; OWNER ADDRESS �� i,�,1. K, ) R iJ CIT\'/STATF./LIP �)E'l�'1� 1 `' C�.� 5 / CON'TRACrOR �> PHONE OI CONTRACTOR ADDRESS CITY/S'I ATF/ZIP LICENSE: ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE; I , WATER TABLE DEPTH: ft GEOCRAPIIIC',\L INFOR.\tAIIOV: Coordinates X ❑ PERC TEST # BUILDING PERMIT#_ LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDI'I'ION ❑_ ENGINEER DL'SlQNED/ LTERNATIVE ❑ REPLACEMENT DE;STRU(TiON INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHFR NUMBER OF LIVING UNITS: NUMBER OP BEDROOMS: NUMBER OF E\tPLOYF,ES: ❑ SEPTIC TANK TYPE/MFG CAPACITY _ gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG_ CAPACITY gal #OFCOMPARIMEN'I'S ❑ PKC TX PLANT DISTANCE TO NEAREST: WFI L_ ft FOUNDATION--_ fl PROPERTY LINE ft ❑ LIFT STATION _ SIZE TYPE:OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSI'E,M) ❑ LEACH LINES ❑ LEACHING CIIAMBERS #of LINES LENG III OF LINES fi DISTANCE:TO NEAREST WELL ti FOUNDATION _ fl PROPERTY LINF-. it ❑ FILTER RED WIDTli _ _ft LENGTH _fi DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION _ ft PROPERTY LINE ft ❑ .MOUNDED WIDTH_ _ft LENGTH R DF.PTIf fi DISTANCE TO NEAREST WELL— (I FOUNDATION fi PROPERTY I INTI II ❑ SUMPS \\lurfl ti LENGTH _fl DEP Iif ft DISTANCE TO NEAREST WELL ft FOUNDATION _ fi PROPERTY I.INE fi C3 DISPOSAL.PONDS WIDTH ft LENGTH ft DEPTH _ fi DISTANCE TO NEAREST WELT__ ft FOUNDATION ft PROPERTY I INE 11 ❑ SEEPAGE PITS Nu%IBER WID'I _ ft DEPTH ft DISTANCE TO NEAREST WELL _ It FOUNDATION _ ft PROPERTY LINE ft I HEREBY CERTIFY THAI'I HAVE:PREPARED THIS APPLICATION AND THE WORK W ILL HE DONT:IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE,LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MIN ��24 HOUR:1D\', V ;NOI'1(_E.RF.QUIRF.D FOR INSPE("PIONS-PLE.ASE.CALL(209)9$i-7697 SIGNED t. C-r r_(% TITLE DATE + ————— ————————— 41 1 ————— - ————— r jC)LT - - � DEPART'hff. S£� ' Y- Application Accepted Date- _ Area Employee ID# `c �I Final Inspection By - Date r/ /U�_ ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Char cter COMMENTS $ �(� fV PE SC Received Che Amount pate Permit/ Code INFO By Cash Remitted Service Request# Invoice# Permit ID# aa.� a 42.02-001 1222.2003 ONSITE.W'AS[I.WATER PERMIT