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5 n <br />ONSITE WASTEWATER TREA'IMEN'C SYSTEMPE 7� QSO-/Oy(v <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE - 3"° FL- STOCKTON CA 95202 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL 9 3-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br />JOB ADDRESS O 1 Z CITY/ZIP /NCv / <br />CROSS STREET A" % 91? � " J� /APN/ OQ�+ ��O'� 90/ �P7ARRC-��GSIZE a 14(:n- <br />OWNER <br />¢� <br />OWNER NAME i /'r� /yVy� /i'f` 3�I bJio4C.y PHONE <br />OWNER ADDRESS �+ ,1 CITY/STATE/ZIP <br />CONTRACTOR cf 1 .H` � PHOVE <br />CONTRACTOR ADDRESS 10,29, CITY/STATE/ZIP d/ <br />LICENSE -42 ❑ C-36 OTHER NUMBER egrEXPIRATION DATE <br />WATER TABLE DEPTH; ft GEOGRAPHICAL INFORMATION: Coordinates X V <br />❑ PERC TEST # BUILDING PERMIT # k4Z LAND USE APPLICATION # <br />TYPE OF WORK: M NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENCTNEER DESIGNED /ALTERNATIVE <br />❑ REPLACEMyEENN� ❑ DESTRUCTION <br />INSTALLATION WILL SERVE: 'Le4O'SIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br />SEPTIC TANK TYPE/MFG 4N4IwTf� l— CAPACITY ��G(.�O PI # OF COMPARTMENTS �1c <br />❑ GREASE TRAP TYPE/MFG CAPACITY Sal # OF COMPARTMENTS <br />13fhtV n <br />PKG TX PLANT DISTANCE TO NEAREST: WELL b It FOUNDATION O ft PROPERTY LMA <br />E C? ft <br />❑ LIFT STATION �tSlz'E TYPE OF PUMP LI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES M -LEACHING CHAMBERS /J / # OF LINES _5 LENGTH of LINES 17LD ft <br />DISTANCE TO NEAREST WELL '25-0 ft FOUNDATION ft PROPERTY LINE � 42^ ft <br />❑ FILTER BED WIDTH ft LENGTH R DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />Cl MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LME ft <br />❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br />SEEPAGE PITS NUMBER_ ,. -WIDTH 3 R DEPTH a.� ft <br />DISTANCE TO NEAREST -ELL---3422- FOUNDATION ft PROPERTY LME % ft <br />1 HEREBY CERTIFY THAT 1 HAVE PREPAF - ACATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORDINANCE. YS ,u10 RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MttJIMUM24 OUR A,' -I E[�JM)TIC', EQUIREG ORINSPECTONS-PLEASE.CALL (209)953-7697 <br />SIGNED 1k/�l'w�/l� l`y�/ „: 1J - - -, <br />TITLE '%'1 DATE - d <br />A <br />°o <br />F <br />W <br />O <br />Q <br />J <br />M <br />T <br />D <br />05 <br />DEPART -MMT USE ONLY j fZy O <br />Application Accepted By Date of /� � Area Employee ID# <br />Final Inspection B(—Date ��� ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth f 3 Ft: .� d- Pit/Su 1 Character: <br />COMMENTS A J i�_ cs7 OF F rP P'Lc,0-0 �M r aa/Q� <br />4202-001 4202-001 <br />12/222003 �- cam r � • . �/�1 X f/Q ,'e2� / 7 <br />Ct-'- /c-_:,1-[` . f.� q:�r-!� � 1..�'.:i�—s�*-;� ca�.�✓�. �' i�r'. •rte'` �Z' � i-�'•r.'.:ry �t'i'' <br />PE <br />SC Received Checldl/ <br />Amount <br />Date Permit/ <br />Code <br />INFO B <br />emitted <br />Service Request # <br />4 L.13I <br />11 -7 1 <br />3'i -o •JJ <br />1 -1 h310 64gObA, 3 6 2- <br />4202-001 4202-001 <br />12/222003 �- cam r � • . �/�1 X f/Q ,'e2� / 7 <br />Ct-'- /c-_:,1-[` . f.� q:�r-!� � 1..�'.:i�—s�*-;� ca�.�✓�. �' i�r'. •rte'` �Z' � i-�'•r.'.:ry �t'i'' <br />