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ONSITE WASTEWATER TIMATMENT SYSTEM PERMIT /ate <br />SAN JOAQUIN COCNTY• ENVIRONAI F.NTAL HEALTH DEPARTMENT 304 E WEBER AVE - 3" FL - STOCKTON CA 95202 - (209) 468.3420 <br />JOBADDRE.SS f - C' CITYrziP <br />CROSS STREET jf. r//�•�' !Com( _ _ __ • APN 6Z �' L� �(�' - .S L— PARCEL SIZE (U• 3f4c. <br />O%4NER NAME ZIL- LJ..e_/4L(�(� 7,�1� iiY I� Lre z P11/0N'F. / <br />O\\\F.R ADDRESS CITi'/STATEJZIP <br />__......._._...___..--- _� —� _ -- - - 111-1. 1 A I UZIP <br />::.::::. <br />LICENSE ❑ C-42 13C-36 GTHE ( N% NLIMBERS!2r y :; <br />EXPIRATION DATE <br />WATER TABLE DEPTH: n GEOCRAPIIICAL INFORMATION: Coordinates X <br />Y <br />❑ PERU TEST N BUILDING PERMIT q `L ¢I03 LAND USE APPLICATION A_S <br />TYPE OF WORK: 1NEWINSTALLATION U RF.PAIR/ADDrfION <br />U ENOINEERDESIGNED/ALTERNATIVE <br />❑ REPLACEMENT 0 DESTRUCTION <br />_ <br />INSTALLATIONWILL SERVE: ❑ RESIDENCE U COMMERCIAL <br />❑ Orimit`J i <br />NL'AIBEROFLIVL\GUNTrS:___ NUMBER OF BEDROOMS: <br />NCMBEROFEAIPLOYEES' <br />d--SEPTICTANK TYPF/NIFG,�/[0�'Y('APACIry L( <br />,tel. Z& <br />gal NOFCOMPARTMENTS <br />❑ C.REASF.TRAP TYPFJMFG__ — CAPACITY —__ <br />gal N OF COMPARTMENTS—_— <br />❑ PKC TX PLANT DISTANCE TO NEAREST: WF.II -- n FOU\DAf10N— <br />R PROPERTY LILAC• _ _ n <br />❑ LIFTSTATION SIZE—__ TYPE OF Pimp L3 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACII LINES ❑ LEACIIINGCHANIBERS___---_ _ _ NOFUNES <br />LENGTII OFLINES___ _ _n <br />DISTANCE TO NEAREST WELL _pp FOUNDATION __n <br />____—n <br />PROPERTY LINE _ R <br />U --vILTERBED Wm1II 4) ,-_-_R LENGTH-__T�, <br />DEPTH 7 <br />DISTANCETONEAREST WELL <br />_:.SCI Cl - R FOUNDATION <br />n PROPERTY'LINE R <br />----- <br />❑ MOUNDED WIDTH _ _-..!—^n LENGHI_ _. _ _—_ __--R <br />DEPTH _-R <br />DISrANCETONEAREST WELL __ R FOUNDATION <br />R PROPERTY LINE. _ R <br />❑ SUMPS WIDTII_. __________—_n LESOIII __- _n <br />DEP711 _ <br />DISTANCETONEARFSr WELL _ _- . n FOUNDATION _ <br />- fl PROPERTY LINE <br />❑ DISPOSAL PONDS WIorR R LENGiII— n <br />DEPTH R <br />DISTANCETONEARESr WELL —____ __ R FOUNDATION <br />R PROPERTY LINE R <br />- <br />❑ SEEPAGE PITS KLAIHER__._—_ WIDTII-__. n <br />DEPTH n <br />DISTANCF.TO NEAREST WELL___ R FOUNDATION <br />n PROPERTY LIKE (I <br />I HERFAYCER11FY TIIAT I HAVE PREPARED THIS APPLICATION AND THE (YORK WILL BY. DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORDINANCES, STATE LAWS AND RULES AND REGLLATIONS OF SAN JOAQUIN COUNTY. <br />MINI% U Y2d IIOUR AD\'ANCI: NOTICE REQUIRED FOR 1NPF:C1'J TNS - PLF.ASF. CALL 12091 95 3-769 7 �\ �y <br />TITLE' .,.__._ DATE �- /e' (c, <br />■■ <br />':.'a::a <br />I <br />::.::::. <br />■■■■■ ■ ■■■■■■■■ <br />i ' <br />::�••• <br />' <br />■...�.■or <br />' <br />■■■ <br />■■■■!��...�....CO==��a■■ <br />! �' <br />mlfL;W <br />■ ■■■■.■■■ ■■ <br />..M, ..CaI.=■■ ... <br />I: C:C'M:.■■:■M NONE <br />aso <br />MI <br />\\4 J c <br />old kbob <br />M. <br />H <br />HOW � <br />a■■��■i�T <br />Ila <br />aa.� <br />.■��■��� i■ a <br />. a <br />....��� <br />■ <br />..�a...�. <br />D .. ■a. ■■ <br />.i <br />11 <br />a■.M <br />a■■ . <br />1 <br />.■ <br />■■ <br />�. ■ <br />■aa■a. <br />a <br />a�111 <br />baa <br />1 <br />■■Elm <br />■ <br />M �:W. <br />I Cad I� r I� <br />..� �.11 ..� f�i■■ONE■ <br />amm <br />1 11 i 11 <br />ON 0 <br />■■. <br />ki <br />DEPARTMENTISE ONLY <br />ApplicationA �<. _- - Datc 1�C jC'�s_.. Ara,-. _-"—. - FmploycelUN 5'3(,b, <br />Final hrspectl R — _..! _ _.`. _ _ -_. ITatc ��/.7%vim ❑ SPECIAL PERMIT-App(med by <br />Character of Soil to Dept o13 Pt: __ _, Pi tl unlp Soil Character:_ <br />COMMENTS AJ6w ��._ o F_L�z r. a !�_ _. _PM � 3 -(! . .._s 1�S M iti <br />> <br />c2 4 n,c!a�r <br />PESC <br />Code <br />INTO <br />Received <br />B <br />CQIeckff/ Amount <br />Cas-ri Remitted <br />Date <br />Permit/ <br />Scnice Rel estill Invo <br />mlfL;W <br />2-1G <br />aso <br />\\4 J c <br />old kbob <br />O!ISITE 1VASTFW'ATFit PFR hlll <br />