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j ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER Avu.3"°FL-STOCKTON CA 95202-(209)46&-3420 <br /> NON-REFI:NDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS _ EXPIRES I YEAR FRo.m DATE ISSUED <br /> JOB ADDAFSS CITYIZIP fr1A 6 <br /> CJI j C- <br /> �fu <br /> CRGSS$'I73e:ET J l'/ APN___ �9 0'Z0 t PARCEL SIZE e <br /> --- -_ 9�• <br /> (M,NFR NAMFPAW ' G <br /> }/J )L-cl r PHONE. <br /> OWNERADDRE.S4 i�7 Q) I+(�,�J/ trtTf R 1r�� CITY/SrATEIZ1P &Qr—L11Q <br /> CONTRACTOR _ cPHON)E <br /> CONTRACTORADDREQS 8074 Lo 0 <br /> CITYISIATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER_ NUMBER EXPIRATION DATE_ _ _n <br /> WATER TABLE DEPTH: - ft GEOGRAPHICALINFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NlJMBEfl LAND USE APPLICATION# <br /> TYPE OF WORK: 13 NEWINSTALLAT•ION REPAIRIA991+6NSE TTAF�K�� �p«IGNED/ALTERNATSVE <br /> O REPLACEMENT O DESTRUCTION y� C% I �J <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: __ NUMBER OF BEDROOMS: NUMBEROFEMPLOYEES: <br /> ❑ SEPTIC TANK TYPElMFG E-"C(S is h A'C'�aE-71E CAPACITY gal a OFCOMPARTMF.NTS -_ <br /> ❑ GREASE TRAP TS'PE/MFG CAPACITY 831 #OF COMPARTMENTS <br /> ❑ <br /> PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION_ _—_ E PROPEKPY LINE ft <br /> ❑ LEFf STATION Size TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENC.LONED SYftEM) <br /> ❑ LEACH LENES O LEACHING CHAMBERS M OF LINES _ LENGTH OF LINES' ft <br /> DISTANCE TO NEAREST WELL tZ FOUNDATION tt PROPERTY LINE ft l <br /> U FILTER BED WIDTH .......... R LENGTH ft DEPr*i <br /> DISTANC rrO NEAREST WELL. ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LEN61H _ti DEPCH R <br /> DISTANCE TO NEAREST WELL_ ft FOUNDATION_ it PROPERTY LINE ft <br /> ❑ SUMPS WIDTH_._.................._..__.............. R LENGTH_ ft DEPTH ft <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION ft PROPERTY LINE f1 <br /> ❑ DISPOSAL PONDS WIDTH___-_------------------------_-__--ft LENGTH ft DEPTH ._..ft <br /> DISTANCE TO NEAREST WE'LL, ft FOUNDATiON R. PROPERTY LINE ft <br /> ❑ SEEPAGE PETS WwTH ft LF.NGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WrI.I.. ft FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND RF.GI ILATKTNS OF SAN JOAQUIN COUNTY. <br /> H ANCENQTICFREQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 11 <br /> SIGNED T1 LF_ DATE r O O <br /> i <br /> Opp <br /> 1 <br /> Q <br /> R l4v Romm <br /> H <br /> i <br /> D� <br /> D <br /> DEPARTMEN USE ONLY <br /> Application Accepted By ,� Date q � .Area p?--/L- Employee ID# I�fSb <br /> Final Inspection B <br /> P� y Date ( 2 Q SPECIAL PERMIT-Approved by <br /> Character of Soil to Lb of 3 Ft: PIUSump Soil Chataclen <br /> COMMENTS f4etwa, /—o� ..Cgfre u..«ka AP-- 0304doE-y,' j=oct_: er_ ..e.y(ZI„ct��rw, <br /> n nw1c.-_Q{-rte+ r.. 7'�.��_-S•ee-h r..-F-p-L ...L! <br /> II•�!�-Gcv4.� ,,-.,,y(... v-c.., be*ct •-t- !..-l2. s s. c Ccv�..�^..I !v �cf'Lt��r-- J 7116/0 <br /> od .NF Received <br /> Amount Date. rmltl Invoice 8 Permit IDp <br /> Codc INFO B Cash muted ervice Request# <br /> -.to Ir-s <br /> a 1-DDI A,"^ Ig„ � rt.tAra'�. enc. ►M+'i' �'i/'V/-Ge✓ <br /> Ih2'02 �. ONSITE ' EWATERPERMIT <br />