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CD ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE. -30"FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT— /, CALI.(209)953-7697 FOR INSPFCTIONS- /'E_XP[IRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 93 TVY /lf ' �d, CITY/7.IP �--((�/]/'d lJ `Q S 3 3 Jit CROSS STREET a oi l /1 L 5( APN /!pp/- 7-�!t7--ZO PARCEL SIZE Z a G OWNER NAMEC PHONE 40 7 —S-162- OWNER ADDRESS S W 100 n CITI'/STATE/ZIP / p]rt/J 611 15-3 3 rJ CONTRACTOR - ✓ w �I C ✓� (i ! tr C�fir` PHONE LZ7 2— CONTRACTOR CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL.INFORMATION: Coordinates X Y ❑ PERC TEST' # BUILDING PERMIT# j-17=07021 Iq LAND USE APPLICATION# TYPE OF WORK: New INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT t �❑ DESTRUCTION INSTALLATION WILL SERVE: Ef.RFSIDFNCE , ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: ,�1 NUMBER OF BEDROOMS: / /� NUMBER OF EMPLOYEES: P3 SEPTICTANK TVPF/MFG ( C�1J CAPACITY, / CiO� gal #OF COMPARTMENTS /❑" GREASE TRAP F TYPE1MFG i I ,CAPACITY I_• gal. #OF COMPARTMENTS ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ftp FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP I ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ^ LEACH LINES,,, LEACHING CHAMBERS t sy #OF LINES c7 LF.\GTH OF LINES ft DISTANCE TO NEAREST WELL .+ ft ., FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST -WELL- "- -- . ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft _LENGTH ft DFPTFI ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH I) DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft L1DISPOSAL PONDS WIDTH ! ft LENGTH' ` ' t ''� tt DEPTH ft DISTANCE TO NEAREST/ WELL . -1-1- , ft , FOUNDATION fl PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE tt 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES STATE LAWS AND RULES AND REGULAIONS OF SAN JOAOL'IN COUNTY. T -�- SIGNEDEll xwv- / 4 -� PERN'NCu ex ]T - /WELL ---- u,m if TEMP HOW S.I 1 , I tY O <7— J- ate �>'yN•1 ON+!�Nr;�n!NO <' _ ateArea 3 Application A—,-- ca Employee ID# Final Inspection ByT44 J/ Date �j1.2 ❑.SPECIAL PERMIT-Approvedby Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS C)LA (_-o7- OF 44P 4111 0 iX i4 jr, jLCCAC 6 ,ee,-4b,�ct' PE Sc Received Che Amount Permit/ Code INFO B Cash Remitted- Date,., _Service R uest# Invoice# Permit IDN, 4Z iI U-7 0o5 42-02-001 "- - - - ONSITE WASTEWATER PERMIT 12/22'2003