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PE SC Received ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE - 310 FL- STOCKTON CA 95202 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL 209 9$3-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED Code INFO B Co _ �/ yT /� "L�"} AN+,3 LSI , CITYIZIP JOB ADDRESS j/-j1t6o I,� Remitted Date PermitlD# Service Request # �G,,^�-K6 � �y CROSS STREET C ` s / APN [ wJ — ( G �`--v`-'- PARCEL SIZE _• �•"t ] �fSt .tnl � � )2r�J OWNER NAME Dhve W�,►7 PHONE OWNERADDRESS CITY/STATE/ZIP n.� CONTRACTOR c�t-iOR�' �fiT 1 t`L �E-yU„�1.NC�1 �J� PHONE CONTRACTOR ADDRESS C IO CITY/STATE/ZIP t_oDi Z.' LICENSE WCA2 ❑ C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # -&-,,(.02(,j7 LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER -2 NUMBER OF BEDROOMS: J NUMBER OF EMPLOYEES: NUMBER OF LIVING UNITS:' I 1" SEPTIC TANK TYPE/MFG VCC,& 'C CAPACITY 1,7.0-o gal # OF COMPARTMENTS Z ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ PKG TX PLANT DISTANCETO NEAREST: WELL I001 R FOUNDATION 20 fl PROPERTY LINE GC' R ❑ LIFT STATION Size TYPE OF PUMP ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ` �t0. ❑ LEACH LINES t% LEACHING CHAMBERS # OF LINES_ LENOTH OF LINES d I R 4 DISTANCE TO NEAREST WELL lot) I+ R FOUNDATION ZZ I R PROPERTY LINE �c'�6 1 ft ❑ FILTER BED WIDTH R LENGTH R Di,pm ft DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R ❑ MOUNDED WIDTH ft LENGTH ft DEPTH R DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R 7l ^�( ❑ SUMPS WIDTH—ft LENGTH It DEPTH ft rf DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LME R ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R ' SEEPAGE PITS NUMBER 3 WIDTH 3Co" ft DEPTH �S F! _ R DISTANCE TO NEAREST WELL LSO t -1-R FOUNDATION Sot ft PROPERTY LINE InO` R I 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL (209) 953-7697 SIGNED TITLE C9-N� DATE I o I I 1 1P(o I 2 ( 1 o r, SNr MDifL p PA DEPARTMENT SE NLY Application Accepted Date 10 f( U(i Area EmployeelD# �.3/O69/ Final Inspection Date !i /• �'j ❑ SPECIAL PERMIT -Approved by Character of Soil to De of 3 Ft: Pit/Sump Soil Character: COMMENTS /06<.✓ /-,VT V F IZEc-c� 2 J - PE SC Received eck#/ Amount Permit/ Code INFO B Co s Remitted Date PermitlD# Service Request # 2-•f3 It �fSt .tnl C/1 bs9x 4gsi5- 42-02/201 1222!2003 ONSITE WASTEWATER PERMIT