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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE - 3"FL- STOCKTON CA 95202 <br />NON-REFUNDABLE PERMIT .` ,1CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROry <br />JOB ADDRESS 4 � 05I�1 clsmne.471 RAO.d CITY/ZIP <br />I"Yv <br />- (209)468.3420 <br />DATE ISSUED <br />CROSSSTRL•L•T R"Id- APN::SlV ql PARCELSIZE 3 _ <br />OWNERNAME %A22kaQ,A`ktV- PHONE <br />OWNER ADDRESS <br />CITYISTATEIZIP <br />CONTRACTORf�.iy1.,.) I%a /%4;; � - PHONE /Zq <br />fb- 5a rJ <br />0 <br />'W90 -C. <br />CONTRACTOR ADDRESS A,,neje 1jKt CITY/S TATEIZIP <br />LICENSE C-42 (3 C-36 OTHER_ NUMBER Nei q �V q!5 EXPIRATION DATE_��ay <br />WATER TABLE DEPTH:_ It GEOGRAPHICALINFORh1AT1ON: Coordinates X y , t� <br />❑ PERC TESTS) NUMDER LAND USE APPLICATION# �]fl <br />TYPE OF WORK: NEW' INSTALLATION -' <br />❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED (ALTERNATIVE <br />❑ REPLACEMENT ❑ DESTRUCTION <br />-------------------------- <br />INSTALLATION WILL SERVE: ) RESIDENCE ❑ COMMERCIAL ❑ O'rH♦ER <br />NUMBER OF LIVING UNITS: 1 NUMBEROPBEDROOMS NUMBER O�EMPIAYEES' <br />❑ SEPTIC TANK TYPVMFG. ( CAPACITY_ %4A"Eal ,Ik OF COMPARTM ENT3 , <br />❑ GREASE ('RAP TVPL(MFG CAPACITY gal#OFCOMPARTMENTS <br />❑ PKG TX PLANT DISTANCETO NEAREST: WELL _9S • ft FOUNDATION l� / Pi J PROPERTY LINE p104P <br />ft <br />O LIFT STATION SIZE TYPE OP PUM1tP ` ❑ SAND( IZSEPARATOR(ENCLOSEDSYSTEM) <br />LEACH LINES ❑ LEACHING CHAMBERS 6iiuv,Q, / # OF LINES a�� <br />LENGTH OF LINES fl <br />DIST-ANCETONEAREST WELL 16V' ft FOUNDATION <br />f00 _R PROPERTY LINE It <br />❑ FILTER BED WIDTH ft LENGTH ft DEPTH <br />_ ft <br />DISTANCE TO NEAREST WELL _ k FOUNDATION fl PROPERTY LINE ft <br />❑ MOUNDED WIDTH tl LENGTH ft DEPTH <br />tt <br />DI57gNCE TO NEAREST WF.I.L ft FOUNDATION ft PROPERTY LINE ft <br />❑ SUMP$ WIDTH ft LENGTH R DEPTH <br />ft <br />DISTANCE TO NEAREST WELL R FOUNDATION ft PROPER( "Y LINE $ <br />❑ DISPOSAL PONDS WIDTH ft LENGTH _ ft DEPTH <br />It <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />16 SEEPAGE PITS WIDTH ft LENGTH �q r <br />ti DEPTH ft <br />DISTANCE TO NEAREST WELL _ / ft FOUNDATION !!W ` 1t PROPERTY LINE ft <br />I HEREBY CERTIFY THAT I HAVE PREYA RED'i'H[S APPLICATION AND THE W'ORY WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAV1'S'AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />NIFI 4 HOU�AE f TICE REQUIRED FOR INSPF.C11ONS - PLEASE CALL (209) 953.7697 <br />SIGNED :,� i- <br />_ TITLE .�1�� <br />""9/i171.'� DATE ♦� <br />Application Accepted By <br />Final Inspectlon R(,/_ <br />Char4cter of Soil & pt <br />COMMENTS j /n. <br />42-01-ooi <br />17/2/02 <br />Arn Employee ID# <br />❑ SPECIAL PERMIT -Approved by <br />ONSITE WASTEWATER PERN•IIT <br />