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.'30 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3YD FL-STOCKTON CA 95202-(209)468-3420 NON-REFUNDABLE PER IT /p ` l'u CA1.1. 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS T �+ CITY/ZIP M tth T t•CJ\ Ice+ 1 5-1 CROSS STREET les j— T-p '1) y /��.�j• APN 2 --71 1b - O PARCEL SIZE p OWNER NAME. ',J� PHONE Vr 6- 7 7 6 / OWNER ADDRESS 44 `r J"S'�L' I�-r!. CITY/STATEPLIP/y sC L&4 L IJ 3�� CONTRACTOR PHONE A CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION ❑ REPAHUADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: ONUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTICTANK TYPE/MFG 1' ` C -1 C EY CAPAC Y � gal #OF COMPARTMENTS Z L3 GREASE TRAP TYPE/MFG CAPA ITY gel #OF COMPARTMENTS I / ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL I O e + ft FOUNDATION�� ft PROPERTY LIN 50^ R ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES R / DISTANCE To NEAARRES�T� WF. R FOUND�/T10N ft PROPERTYLINE R ri 1..1 FILTER BED WIDTH ] R LENGTH f�• R DEPTH / \ r DISTANCE TO NEAREST WELL L 0 D + R FOUNDATION R PROPERTY LINE r R ❑ MOUNDED WIDTH R LENGTH ft DEPTH R `f DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE. R ❑ SUMPS WIDTH 0 LENGTH ft DEPTH fl DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE 11 ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH ft DISTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE R ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH R DISTANCE To NEAREST WELL. ft FOUNDATION ft PROPERTY LINE R I 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 REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM24 HOU ADV CF.NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 1209)953-7697 / 7 SI(: F'. ND '//._�✓ 'f / TITLE. tei t_&/l DATE I//C.(i I LAN JOPa�INENT� i 7 '�.... f ff � YIRJ ---^.- I •�S 7 q23 }- 4 ARTMENT US O__. __ _ Application Accepted By to Arca - Employee ID# Q - - -- Final Inspection By IV ❑ SPECIAL PERMIT-Approved by Character of Soil to De th of 3 Ft: Pi mp Soil C Mer: COMMENTS PE SC eceived -AcAeeldM- Amount Pe U Code INFO B -CasA' Remitted ate Service R nest# Invoice# Permit ID# Z LI��, 570 ' � 5 42-02-001 ONSITE WASTEWATER PERMIT 12222003