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00 ONSITE WASTEWATER 'T'REA'TMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONSIENTAL II EALTII DEPARTMENT 304 E WEBER AYE.-3-FL-STOCKTON CA 95202 - (209) 468.3420 NON-REFUNDABLE PERMIT CALL. (209) 953-7697 FOR INSPECTIONS F.YPIARC 1 VCAv ronin nATr lecu— JOB ADDRESS1 O Y..L ' — ` CITY/'LIP / � CROSS STREET G R (' Y-- (�/�� p !� C APN -- O �) 0 - jPARCEL. SIZE W . -%✓ OYYVER NAME O �e�i �JyV�� `\ 1 pay OQ �PII-O'-NE__ OKVER ADDRESS { _` O AYj9 � � L oar _ CITY/STATFJZIP_ Z�1 CONTRACTOR .-- %. 1. Z- — 2. CONTRACTOR ADDRESS _ CITY AFFJ'IIP LICENSE. 0C-42 0C-36 OTNER_ _ NUMBER EKPIRATIONDATE WATER TABLE DEPTH: R GEOGRAPHICALINFOR.YIATION: Coordinates X Y 121 PERC TEST N t BUILDING PERMIT N ❑ MOUNDED LAND USE APPLICATION N TYPE OF WORKI ❑ NEW INSTALLATION Cl REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ SUMPS ❑ REPLACEMENT _ _ _ ❑ DESTRUCTION INSTALLATIONWILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF F,aIPLOYEES: ❑ SEPIICTANK TYPE/MFG _ CAPACITY ___ gal d OF COMPARTMENTS___— C ❑ GREASETRAP 7YPE/hIFG _. __.,. CAPACITY—__—__` gal N OF COMPARTMENTS ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL __ ____ R FOUNDATION _ __ R PROPERTY LINE ---- __ R ❑ L117TSTATION SIZE TYPEOFPVNIP_ _ ❑ SAND OIL. SEPARATOR (ENCLOSED SYSTEM) ❑ LEACII LINES ■ ❑ 1,EACIIING CIIANIBERS_ __ NOF LINES LENGTH Of LINES __ R so MMMMMMMMM■ Esq. DISTANCETO NEAREST WELL R FOUNDATIONR PROPERTY LINE ■■■ N■I ❑ FILTER BED WIDTH _ ___it LENGTH _ _ _ _ R DErm MEN i ■ R O�i�■■■■ ■■■■■�� ■ DIS"rANCETONEAREST WELL _ R FOUNDATION R PROPERTY LINE — ft ❑ MOUNDED WIDTH _--___ _R LENGTH _....__ ._._ _._R DEPTH _ _....--R SOON ■S � DISTANCE TO NEAREST WELL _ _ R FOUNDATION -_. R PROPERTY LINE _ R ❑ SUMPS WIDTII__ (l LENGTHR DEPT)i R moll 1 ■■�■ .■■ DISTANCE. TO NEAREST WELL. _--_ _ _ R FOUNDATION _ n _ n PROPERTY LINE -. ---ft ❑ DISPOSAL PONDS WIDTJI _.._ ----____R I.E%GTII _-_ _ ,_--- .- _ _ R DEPTH - -, .----------- —R DISTANCE TO NEAREST WELL__ _-_ -__R FOUNDATIONR PROPERTY LINE R ❑ SEEPAGE PITS NUMBER K'IDTnR DEPTH _ R � �.� DISTANCETONEAR6.ST WELL—ft FOUNDATION R PROPERTY LINE R I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK KILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 0 �i�N■ Nil. fU11 24 HOUR ADVANCE NO'rICE ItEQUIkFaY 1'OR INSI'ECFIONS - I'I,F.ASF. CAI.I. (2091953.7697 _ SIGNED L OGa \�iY - TITLE. C -c—\- DATE )� ■■ 0 MEMO ■■■�■�■■�N■i so MMMMMMMMM■ Esq. ■ ■O■■■■ ■■ ONE sN�; 1,■■■ ■■■ N■I ■■ ■■ ■■■ MEN i ■ R O�i�■■■■ ■■■■■�� ■ N■1� 7 ■ ■■■■�11,00 ■■ ■r ■ ■I��■■ ■ ■� NSI 0101 �■ ■ NINI■N■ ■■ NS 1� �■■ ■■ ■N1 ■L; i SOON ■S � ■■ N■■ ■■■I • ■■■�■�I�■■■ ■ ■■■�■ F■SN!�I.11■� � �� ■■ ■ ■m " �N� moll 1 ■■�■ .■■ ■■■Ni ��■01%�■■i �N■I: F ■ ,�N�1 I ■ !� mL'r' N0�I�. � �.� ■■■ ■ IO■ ii f11�11 ■ill t�l��ilu �i�■■■�� ■�1'Y SIN iN� � � 0 �i�N■ „ , . ■ ■■N ■ ■ ■ ■■■ ■■��■ r�■ 1��■� ■ ■ FA -- .. � mill , � mill .m� N■■. DtiPA Dalet F,��iSE Z� ^ Arca Employee IDd Application Ac ed _ (� p Final 111 Mee an13y /.•' _�, yam,/ _ Dnlc /4_� d�_ ❑ SPECIAL. PERMIT - Appro%cdby_ Character or oil to Depth or FI:_ PIOSunlpSoil Characfer:____ _ COMMENTS _ _ s,�c• �'x_ �d,�xs�._y�—+__� .c.C'C��c-�-� 17%...1 L_... PE SC ReceivedhcckU/� Amount Permit/ Code Poo By I Yh I 17nmurrd Date c��.:�a D��.��a N invoice Permit IDN 00 —_11*1 1202.001 ONSIIF WASIFWAIPR PFRMIT 12 212001 Me