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ONSITE wASTlnVATER TREATMENT SYSTEM PERM1P*e!S-O=IDz/,0 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE - 340 FL- STOCKTON CA 95202 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL 9 3-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 0 I v /.+� ♦ ` CITY/ZIP M 3 <br />CROSS STREET /•I% V _ APN©g v�7 <br />0 <br />OWNER NAME <br />OWNER ADDRESS/�/ •• \ <br />-V <br />V <br />��� ` � I �•PARCE�SIZE O ITG... <br />PRONE LS�J ' <br />CITY/STATE/ZIP <br />CONTRACFOR ADDRESS <br />u CITYISTATE/ZIP <br />LICENSE -42 <br />❑ C-36 OTHER NUMBER EXPIRATION DATE AMM I <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X V <br />(�.• <br />❑ ERC TEST # <br />BUILDING PERMIT # LAND USE APPLICATION # <br />v <br />TYPE OF WORK: <br />1K EW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br />❑ REPLACEMENT 13 DESTRUCTION <br />INSTALLATION WILL SERVE: -ef-RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES.- <br />MPLOYEES: <br />.,.,! <br />//�J�� <br />SEPTIC <br />LT SEPTIC TANK <br />I��1,�-JJ <br />TYPE/MFG [.1R�J&- � CAPACITY ISO gal # OFCOMPARTMENTS <br />, <br />❑ GREASE TRAP <br />TYPE/MFG 1 CAPACITY gal # OF COMPARTMENTS <br />LlPKG TX PLANT <br />n <br />DISTANCE TO NEAREST: WELL Ptd fC/ ft FOUNDATION AAD ft PROPERTY LINE (9.40 R <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />AL LEACH LINES <br />16-•LJ,S <br />EACHING CHAMBERS I�GJt / ! # OF LINES _ 3 LENGTH OF LINES 2140 ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE �Q ft <br />❑ FILTER BED <br />WIDTH ft LENGTH R DEPTH ft <br />DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br />\� <br />t �Y <br />❑ MOUNDED <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br />❑ SUMPS <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br />❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br />SEEPAGE PITS <br />NUMBER— .. _WIVTH It DEPTH �C' ft <br />DISTANCE TO NEAREST VELL -, ft FOUNDATION ,FjQ— ft PROPERTY LINE ate• -O ft <br />1 HEREBY CERTIFY THAT 1 HAVE PREPAP-'!.ICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORDINANCE.: VS -10 RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />A i1MUM2d OUR I N/OI,jC'. EQUIREIG CALL (209)953-7697 <br />SIGNED <br />'sORINSPECTONS-PLEASE <br />TITLE �L= d- <br />DATE <br />I <br />Application Accepted By <br />Final Inspection B <br />CharacterorSoiltoDepth f3 Ft: <br />COMMENTS Al�c�t L <br />fir./r�._..e !/fi .y.• <br />PE SC Received <br />Code INFO B <br />'.{Z,3 1 11-7 /1 <br />005 <br />.._ DEPARTMEM USE ONLY�....- <br />_�-- <br />Date/��/ ��J' Area Employee ID# S3 (c E+ � Q�3 <br />Date ��%� ❑ SPECIAL PERMIT -Approved by / <br />✓F� Pit/Su'�Char: <br />/a'l acteri <br />'Remitted I Date I Service Request #ylnvolee # <br />;j"LC•JJ �"1/i3�of15�DDd-.3bt2.��L <br />42.02-001RAERM <br />12/22/2003 ��s`iri G/.y�. ��Xt✓ / �� XY a •Cs�.�/r1''AS4" •'A''E,>:/.7 <br />i'r,ra�r'st' �<,y,'.:, > •C <br />