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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL.HEALTH DEPARTMENT 304 E WEBER AVE.J"'FL-STOCKTON CA 95201 -(209)465-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INspecrims EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS f 3 x/ S .Pv�,.����_ CITY21P /Tf�v y Lb <br /> CROSS M-RF.ET C--,L I,iz/ APN12� ' <br /> PARCEL SIZE o <br /> OWNER INAM1tE _[',gtplr &"L <br /> L PHONE <br /> OWNER ADDRE. _S�Jm( CITYJSTATL(ZIP �l Pe-•'s'� <br /> :i <br /> CONTRACTOR _C ht(-1= /�j?/7/.d PHONNC—�o.y r11_ qy S <br /> CONTRACTOR ADDRIFA`_ 2 <,.r 11 �,+�_... C11IJ---S CIT ;U <br /> YISTATFiP CAg,� �c,••Y. !tA <br /> LICENSE O C-42 <br /> 63 <br /> 6 OTHER Imo-= NU:NBER EXPIRATION DATE ! <br /> ' WATER TABLE DEPTH: t1 GEOGRAPHICAL INFORMATION: CODrdinates X Y <br /> CD PERC TEST(S) Nt:UPIER _ LAND USE APPLICATION 4 F 1 <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR! N ❑ ENCINEERDTLSICNEDIALTERNATIVE <br /> ❑ REPLACEMENT k ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OP BEDROOMS: A NUMBER OFEMPLOYEEti: <br /> SEPTIC TANK TYPEIMFG_- CAPACITY IgGy gal is OF COMPARTMENTS 'L___ �'• <br /> ❑ GREASE TRAP TYPF MFG CAPACITY <br /> _.,_ gel #UF'COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETO NEARENI': WELL _ 11 FOUVDATION H PROPERTY LINE <br /> — R — <br /> ❑ LIFT STATION SIZE TVPEOFPump ❑ SAND OIL SEPARATOR(ENCLOSEDSYSTEM) O• <br /> ,. A,� S <br /> •. I LEACH LINES 13LEACHINC CHAMBERS #OF LINES LENGTH OF LINES <br /> I•'• — r y�f <br /> *• DISTANCE ToNF.AREST WELL — R <br /> �H FOUNDATION H PROYERIYL7 (D H <br /> E3FILTERLENGTH FILTER BED WIDTH — <br /> .. .___ R <br /> DEPTH g <br /> i DISTANCETO NFwREST WELL— —� R FOUNDATION <br /> ❑ MOUNDED WlR PROPERTY LIN): }l <br /> '. o•IH _ _11 LENGTH _}t DEPTH <br /> t't _ <br /> • DISTANCETONEARTSI• WELL fl FOUVDATION H PROPERTYLINE _ ft <br /> ❑ SUMPS WIDTH _H LENGTH R DEPTH..__ <br /> y DISTANCE TO NEAREST WELL R fl <br /> FOUNDATION H PROPERTY LINE ft 'T <br /> ❑ DISPOSAL PONDS Wimu_ ft LENGTH _ H DEPTH_ ft <br /> ❑ SEEPAGE PITS Wu <br /> DISTANCE TO NEAREST WELL ._H FOUNDAT?ON ft PROPERTY UNE It <br /> mt R LENGTH ft DEPTH <br /> -- -.-...._ ft <br /> DISTANCE T'ONEARFST WELL f1 FOUNOATION H PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 HAVE.PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> 1 STATE LAWS AND RULES AND REGULATIONS OP SAN JOAQUIN CY)L4\'TV. <br /> UM 7A HOUR ADVANCE NOTICE REQUIRED FOR ENSPECTIONS-PLEASE CALL(209)9$3.7697 <br /> SIGNED \ <br /> _ TITLE_Cj[AJyli tsl2 DATE <br /> t <br /> vA <br /> i <br /> t � <br /> X1 <br /> `r <br /> of <br /> A N <br /> I DEPARTMENT USE ONLY <br /> Appdntloa Accepted B)' Det: Z.�0 3 Area F:mployce 1D# n <br /> �r// <br /> _`i� <br /> Elul Inspection By Drte © SPECIAL PERMIT- <br /> ' Cderecter of Soil t ptd o C APpro�ed by <br /> COMMENTS Pit/Sump Soli Chitracter: <br /> PE SC Received Check#/ Amount Pertrdd <br /> Cede INFO BRemitted Date Invoict# P.,naID# <br /> x'Q "-,-R nes" <br /> S <br /> 42-01-001 <br /> 1=102 <br /> ONSITE WASTEWATER PERMIT <br />