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ISI, UU ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3YO FL-STOCKTON CA 95202 -(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS D CITY/ZIP d rn CROSS STREET 0/12 APN �5 7— Z 7-5--102- PARCEL SIZE 0-2-11 p OWNER NAME /' 3/� PHONE rM 'may�OAQUIN COUNTY OWNERADDRESS cN�. -- ETARTMI=NT sepclCONTRACTOR &xA44& l/ ON CONTRACTOR ADDRESS D CITY/STATE/ZIP LICENSE A C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT DESTRUCTION D TSN �jQCINSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: 2_ NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG �,C� CAPACITY D gal #OF COMPARTMENT ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ PKC TX PLANT DISTANCE To NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE It ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH it DISTANCE TO NEARS WELL ft FOUN ATI ft PR ERTY LI .Ad SUMPS WIDTH / ft LENGTH O✓ R DEPTH DISTANCE TO NE ESF WELL OUNDATION le�f R ROPER INE �-.f R 1 ❑ DISPOSAL PONDS WIDTH ft LENG7 ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft �( ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft T DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY (n ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIM 4 HOU ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE [/ DATE O U 3 p N N AE T17 I MpWENr o Fi N A01 lit, s X6 T L ' T Mal I DEPARTMENT.USE ONLY / Application Accepted By Date (,,,/0 6 Area Employee ID# GAG Final Inspection By Date /06 SPECIAL PERMIT-Approved byX Character of Soil to Depth of 3 Ft: Pit/lump Soil Ch ra ter: COMMENTS oe-A L,7-0 4-jrc-c; -Ti--)E2 E-7- .v 0T 04-VA(L-Az A LAC— fo10-71trs A,q.,Q�-�(_ .5-9c— I ETt-f,/L w�Co �ISU-L--r 47Tu j 1.1j / LLaLi-T FIBS S�EC.I AL ToE AP-4 LT- ACQLA/r2E� �zt� I✓k�oF /�rt7E Cr L(46`E. SP f C ti tc- L��4G G✓ i�S D i�t t� S on) ✓T47�Ot�S 4IVfo PE SC Received Checldi Amount Date Permit/ Invoice# Permit IDN Code INFO B ash Remitted Service Request# 4z./ !!s p o o•oa DL 42-02-001 �j/Ll D� �'-` /V, /ON STEWATER PERMIT 1222/2003