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P <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTALHEALTH DEPARTMENT 304 E WEBER AVE -3'FL- STGCKTON CA 9$202 - (209)468-3420 <br />NO -REFUNDABLE PERMIT CA H, (209) 953-7697 FOR INSPECTIDNs I V .AR FROM DATE ISSUED <br />]OB ADDRESS (Xg <br />/ /E^XPIRES <br />]Sl L% • W a L7(%e %aL., U C CITYIZIP—r—(17�]�iIlt' 2 2 <br />CROSS STREET <br />All (.( M3 060 P) R('EI.SIZE _ <br />OWNER NAME <br />�� rO L'^-4 S CCA' 9'`^11' PI IONP: <br />i r <br />OWNER ADDRESS <br />CITYISTATErZIP <br />CONTRACTOR <br />�� <br />�J `/•� , I7 -(' <br />V '-1 '/ PHONE' vU /yf 3 (,7V <br />--9 ( <br />COMMENTS ` 4" <br />CONTRACTOR ADDRESS <br />-' L sJ L L CITYISTATErZ[P <br />DISTANCETONEAREST �LI. R FO l DAT R PROPERTY LINE <br />LICENSE 42 <br />C) C-36 OTHRR NUMBEREXPIRATIONDATE -O <br />WATER TANIE DF:Prw <br />�OIJT'✓4 ft GEOGRAPHICALINFORAIATION: Coordinates X Y <br />❑ PERC TEST N <br />_ BUILDING PERMIT N LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEWINSTALLATION ❑ REPAIR/ADDITION 'CINEER DESIGNED !ALTERNATIVE <br />R <br />❑ REPI.ACEMF.NT ❑ DESTRUCTION <br />INSTALLATION WILL <br />SERVE: ESIDENCE ❑ COmMERCIAL ❑ OTHER <br />NUMBEROFLIVINGUNrrS: NUMBEROFBEDROOMS: NUMRF.ROFEMPI.OYEEs: <br />SEPTICTANK . <br />TYPE/MFG_(ieLe-- %KCry1rS _ - CAPACITY 1'Z gat #OFCOMPARTMENTS_y��_ <br />❑ GREASE TRAP <br />TYPE/MFG CAPACITY Sal q OF COMPARTMENTS <br />❑ PKC TX PLANT <br />DISTANCE TO NEAREST: WELL It FOUNDATION it PROPERTY LINE _ P <br />�L.IrTSTATION <br />SIZE (WO TYPEOFPuMP [)tQ--LO ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) — <br />❑ <br />LEACII LINES ❑ LEACHING CHAMBER �••^'� - 9Of'LIN' )N LF.NCrH OF1arvES <br />R <br />P <br />Area Employco IDq S 3� <br />DISTANCE To NEAREST WELL % FOUNDATION' It ROPERTY LINE <br />R <br />to <br />❑ <br />_ <br />FILTER RED WIDTiI ft/MOTH lk DEM <br />R <br />I'll/Sump Soil. Ch ratter: <br />COMMENTS ` 4" <br />DISTANCETONEAREST �LI. R FO l DAT R PROPERTY LINE <br />R <br />❑ <br />l <br />MOUNDED WIDnI It ENGTH R PTH <br />R-, <br />DISTANCE •ST WELL ft rouNDATION (( PROPERTY LINE <br />R <br />r~ <br />❑ <br />SUMPS WIu'TN NOT -1 DEPTH <br />Code INFO B Cash Remitted <br />OU O 11 PROPERTY LINE <br />DIbTANCETO. EAREST ELL __g�:7 <br />P. <br />❑ <br />DISPOSAL PONDS WIDTR ` R LENGft DEPnI <br />R <br />DISTANCETO. 'ARESr WEIR.ION It PROPERTY LINE <br />R <br />❑ <br />SEEPAGE PITS NUMBER Wmnt ft DEPTH <br />R <br />ONSITE WASTEWATER PF,RMI ' <br />,�'Y•7;' Ty <br />DISTANCE TO NEAREST WELL n FOUNDATION n PROPERTY LINE <br />R <br />I'd b899-896-t30Z <br />�OTeuQsruTwpd e0E:60 90 TO QaQ <br />1 HEREBY CERT'IFYI 'HAT I HAVE. PREPARED THIS APPLICATION AND THF. WORK WII.I. RF. DONE IN ACCORDANCE WriH SAN JOAQUIN COUNTY <br />ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />12FOR NSI'F:(T•hD\S- PLEASE CALl. (209) 953.7697 <br />' <br />SIGNED TITLE //Z— DATE <br />PAYMENT <br />RECEIVED <br />DEC 0 1 2006 <br />bAN JOAQUIN COUNTY <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />DF �RI•MENT I;SF. O.' <br />.\' c <br />/ <br />Application Accepted _ <br />- <br />Area Employco IDq S 3� <br />�/ <br />/ / �� <br />Final Inspection By <br />to <br />.," SPECIAL PERMIT -Approved by <br />/// <br />Character of Sell to Depth of 3 Ft: <br />I'll/Sump Soil. Ch ratter: <br />COMMENTS ` 4" <br />PE SC Recelved Check41 Amount <br />Date <br />Permit/ rnd <br />Involceq PetlDq <br />Code INFO B Cash Remitted <br />Servlcc Re ucetM <br />i <br />h( O� <br />�N% <br />L S <br />42-02-001 (.�(� !1 f ll('' C �'��" a • • O S <br />ONSITE WASTEWATER PF,RMI ' <br />,�'Y•7;' Ty <br />12/222003 <br />I'd b899-896-t30Z <br />�OTeuQsruTwpd e0E:60 90 TO QaQ <br />