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ONSITE WASTEWATER TREATMENT SYSTEM PERMI'�CANNED <br /> OUVTV ENVIROAMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3"'FL-STOCKTON CA 95202 -(209)468-3420 <br /> UNDABLE PERMIT CALL(209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> W <br /> . �— <br /> RESS Sp CrTYr71P <br /> > <br /> o0>o <br /> /y/J'��J-G•��//C��/�• J �G APN 2.53- 2r0-�O PHONE aAcet.Sl� 34 <br /> SSSTEET � AlRjqtd�A7C�py <br /> OWNERV,ME CITY/STATFIZIP <br /> OWNER ADDRESS (I/, <br /> CONTRACTOR r� `2 PHONE <br /> CONTRACTOR ADDRESS CITYMATEJZJP <br /> LICENSE -42 ❑C-36 OTHER NUMBER_ ExPIRATION DATE_ <br /> WATER TA EpTN:_ <br /> ft GEOGRAPHICALINPOKMATION. Co"inalea X Y <br /> ❑ PERC TEST #—� BUILDING PERMIT# rYr Ln N G- KLO- ND USE APPLICATION 4 <br /> TYPE OF WORK: L3 NEW INSTALIATION REPAIR/ADDfTiON ❑ ENGINEER DPSIGNED!ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: Q RESIDENCE � COMMERCIAL Q OTHER <br /> INSTALLATION <br /> N UMBER OF BEDROQMS: - NUM6ER OF EMPLOYEES: <br /> 10 SEPTIC TANK TYPE/MFG- t CAPACITY D 9`1 #OF COMPARTMENTS,_ <br /> Q- 4F TYPE/MFG e I #OF COMPARTMENTS PAC[TY gs <br /> ❑ PKC TX P NT DISTANCE TO NtARFST: WEu. R FOLRIDA ION _ <br /> fl PROPERTY LINE ft <br /> LIFT STA'ION SIZE TYPE Of PUMP_all Z iQ' -y [3 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> (AJ <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LIVES LENGTH OF LINES <br /> ft W <br /> ft PROPERTY LINE R <br /> j DISTANC AREST R"F.LL FOUNDAT3ON L <br /> �/ `/ DEPTH R <br /> i FILTER BED WIDTH R LENGTH R , <br /> DISTAN NEAREST WFL1. ft F DATION R PROPERTY LINE r� <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH <br /> R <br /> DISTANCE TO NEAREST WELL._ R FOUNDATION R PROPERTY LINE R t <br /> ❑ SUMP$ I WIDTH - ft LENGTH <br /> ft DEPTH ft 2 <br /> I DISTANCE TONFaREST WELLft FOUNDATION R PROPERTY LINE R 1}I <br /> O DISPOSAL;PONDS WIDTH R LENGTH_ fc DEH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION' fl PROPERTY LIVE fl <br /> ❑ SEEPAGEiPI7S NuMeea WIDTH ft DEFIH ft <br /> DISTANCE TO NEAREST <br /> WELL <br /> ft s01,•NDATiOV ft PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND i HE WORK WILL,BE DONE IN ACCORDANCE WITN SAN JOAQWN C(R1NTY <br /> ORDINANCES,STATE LAWS AND RUL"AND Ri..MLAInONS OF SAN JOAQUIN COUNTY. <br /> NIM 24 HOU DVANCZ NOTICE RowiiiiinR PORVlI�fL>:�►+6" ' T'`L1'('0g1453.7697 - <br /> �. .TTrL1 DATE CJ <br /> SIGNED <br /> zi <br /> tx <br /> zi <br /> AI --- .. +-----.. <br /> _ -� / t <br /> fi <br /> 046 <br /> r <br /> Q <br /> DILPARTMENT Y <br /> �G�fS / <br /> Application Awep:ed B3'_ <br /> � Date G(O Alxa Employee ID# <br /> Final Inapettton By Date Je� ❑ SPECIAL PERMIT-Approved by <br /> Character rr(fo to Depth of 3 Ft: It/Sump Sail Character: <br /> COMMENTS <br /> II /11✓r�n/cT�.4 71E L oADr s(a s'7Lttl J4d t�JrJ�z�9oDA/� <br /> rt= 5 u ✓� I21sUt S' . FT !�7f.� Ed. Oi-D L-o7-OF Akc-"4-6 <br /> • PE SCS, Received Ck"kW Amouat Date Permit! Invoice# Perdt IDR <br /> Code INFO B ps�� Remitted Strvl <br /> 2-L5 yT+ <br /> 0 <br /> 6J FsU UO 3 ZJ� <br /> y. <br /> ONSITE WASTEWATER PERMIT <br /> 42.02401 <br /> 121271200 <br />