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1�6 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3"FL-STOCKTON CA 95202-(2191468.3420 <br /> NUN-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES i YEAR FROM DATE ISSUED <br /> JOB ADDREAS '' ,/` CITYlZIP Com' <br /> CR(w STREET APN t G G 3 PARCEL SIZE <br /> A <br /> OWNER NAME C�t.,r` �.-►'��'L'P'"--" PHONE }� <br /> OWNER ADDRESS s{�rl.�it i _. CITYISTA'I'EYI.IY „_ •• <br /> r r <br /> CO\TRACTORK'• �• PHONE - .�rL.S '�[' `'/�i•�� <br /> CONTRACTOR An ESS I,-"5TArE/ZtP <br /> LICENSE C42 ❑C-36 OTHER _ NUMBE C EXPIRATION DATE + <br /> WATER TABLE DEPTH:_ _ ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> i ❑ PERC TEST # B111L.DING PERMIT#/ LAND USE APPLICATION# <br /> TYPE OF WORK: U NEW tNSTAL.LATIoN W REPAIRIADDITION ❑ ENGINEERDESIoNEOlALTERNATIVE <br /> ❑ REPLACP.MF.NT Q Durau na,4 <br /> INSTALLATION WILL NERVE: RE$IOPNCF. CDMMr.RctNJ, ❑ OTHER <br /> N'UMREROFLIVINCLNff': N[MRSA OF RF.DROOMS:, { NUMRFR OF EMPLOYEES: <br /> ❑ SEPTICTANK ✓ TYtumm- f`L— CAPACIIY• ZJ�e p1 NOF'COMPAHTMENTSj <br /> ❑ CREASE TRAP TVPPJMFC __ _ CAPACITY - gal #OFCOMPARTMENTS <br /> ❑ PKG TX PLANT DibTANCE TO NEAREST: W F.I.I. - A r.NDATION ._... fl PROPERTY LINE_, R "'— <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH I.1NES ❑ LEACHING CHAMBERS a Of LINES LENGTH OF LINES <br /> DurrANCETONEARPST V.•FI.L - ft PO*.;NDATION fi PROPCR7Y IANE R <br /> ❑ FILTER BED WIDTH ft LENGTH <br /> DISTANCE TO NEAREST WFl.I. ft FOUNDATION , fl PROPERTY LINE It V <br /> ❑ MOUNDED WIDTH It ISNGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL_.. ft FOUNDATION_ fl PROPERTY LME _, ft <br /> ❑ SI:mn WIDTH ft LrNOTH ft DEPTH R C5 <br /> D18TANtz TO NEARE:4F WELL ft WUNDAI ION __ Il PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH_r 6 DEPTH IZ M <br /> DISTANCR To NEAust, WELL ft FOUNDATION ft PROPPRTY LINO___•. R <br /> U SEEPAGE PITS Nt"Zint WIDTH ft DEPnI R <br /> DISEANCE TO NEAREST WPJ.I, It TOVADATION 11 PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND T. WORX WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES.STATE LAWS AND RULES AND RECV LATIONS OF SAN JOAQUIN COUNTY. <br /> :ill NIMI; UHOURA VANCENOTICE 'I RED FOR INSPECTIONS-PLD:ASE CALL(709)953.7697 <br /> SIGNED f U TITLE_ DATE <br /> t t <br /> r / I IkArl <br /> + <br /> .00 <br /> i <br /> t <br /> R N E A <br /> �IG1 <br /> DEPARTMENT USE ONLY p 9.�w7Aq' <br /> Application AemptWBy Yj Q 114 P Date 0 b Area _._..J� _ umpluycc 1QN <br /> Final Inapccilon 13y , Date ❑ SPECIAL PERMIT-Approved by_ <br /> Character of Soil to Depth of 3 Fc __.,. _ Pit/So p Soil <br /> Charactert <br /> COMMENTS_eZ A7;;a&L' .ACE&AMn/- � A- <br /> z-v71-.e, <br /> z"'L e, i-�.,ate: - � ,>.e7 er7t� �Kt. GL•S <br /> 2cs_ i rY..s. Dui ��I fL=c —� <br /> FE SC Received Amount Ice p Permit Do <br /> - <br /> S, <br /> INFO Cash Remitted Date tJclvice vert# <br /> 2 (0 s J .UO � U <br /> 42.02-p01y7_.%R.'•C,' `{�"7 -.. lf.(./Ari t`r.t i <br /> ONRI'1e WASTEWATER PERMIT <br /> 12n212003 t •} <br />