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ONSITE; WASTEWATER TREATMENT SYSTEM PERMIT <br />- ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />h <br />h <br />ft <br />R <br />ft <br />h <br />SAN JOAQUIN COUNTY ENVIRONh1ENTAL HEALTFI DEPARTtIENT 304E WEBER AVE. -31 " FL- STOCKTON CA 95202 - (209) 468-3420 <br />1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />p <br />30BA DRESS 2/��♦//� e LR hVj Q{1 $ CITYIZI/p� <br />� <br />/L <br />CRO STREET / ! /�Ph�LQN 4i4 1 /O� UtG .3 <br />APN 0-5 ` 6 PARCEL S12E 9' C�y�c <br />`[ <br />S I <br />Ir L) / <br />OWN .NAME She ✓'Qh �i�.2t T/1eh `Lee- 444 P- PHONE <br />TITLE Lyl-I.py DATE l7`-�.a� a3 <br />OWN1�ADDI ESS S7 � 7 i�1 , �-F WI.pN �f7� %�/pr CITY/STATEIZIP <br />� /` <br />CONTRACTOR � 12 0 T-P�aN-&z I,- x --)>- <br />--)>, PHONEAn <br />^�1 /'�flt�/y' <br />2f <br />CONTRACTOR ADDRESS /n (I& ( �l :L 6: CITY/STATE21P <br />�y <br />LICENSE ❑ C-42 ❑ C-36 OTHER NUM1IBER EXPIRATION DATE <br />1 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: CaOrdinetM X y <br />'jam-_` If <br />❑ PERC TEST (S) NUMBER LAND USE APPLICATION # <br />TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ E GINEER DESIGNED/ALTERNATIVE <br />❑ REPLACEMENT DESTRUCTION [r <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBEROFLIYINGUNITS: NUMBER OF BEDROOMS; ,INU It•,FF,M1f YEE e� a0 <br />❑ SEPTIC TANK TYPE/MFG CAPACITY <br />J P <br />ga RTD <br />❑ GREASE TRAP TYPE/MFO CAPACITY <br />❑ <br />PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION 6, {`�jo"� 1 JL,, <br />V Ui'IIIjEbT6hVj��le <br />❑ LIFT STATION SITE TY'P£OFPUMP ❑ SANDO&SEPAARRy(EncLosgySnSreM}l;• <br />❑ 'LEACH LINES ❑ LEACHING CHAMBERS�1 <br /># OF LINES LENGTH OF LINES <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />O FILTER BED WIDTH -ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />❑ MOUNDED WIDTH h LENGTH ft DEPTH <br />DISTANCETONEAREST WELL FOUNDATION—ft PROPERTY LINE <br />❑ SUMPS WIDTHft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />LI DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE <br />CI SEEPAGE PITS WIDTH ft LENgTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />- ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />h <br />h <br />ft <br />R <br />ft <br />h <br />!$y\\ <br />p <br />1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMU 24HOURADVA ENOT ERF.QUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />TITLE Lyl-I.py DATE l7`-�.a� a3 <br />Final Inspection By <br />Character of Sall to Deptb o13 Ft: <br />COMMENTS ,{/o ee <br />INFO <br />DEPARTM17E SE LY Em to ee ID# <br />Date ❑ SPECIAL PERMIT - Approved by <br />Pit/SumpSol C ararter <br />Date <br />Invoice9 1 Permit ID* <br />42.01-001 ; - ` _ - - —,," - s —_ - �� —.. --7—.. — <br />12/2/02 IGP C�/y,(.�,Vy�G(•1.e�y� lzo�-�+tL C$cj.� ` ' ONSITE WASTEWATER PERMIT <br />�� J <br />