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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT (LI w <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HLALTH DEPARTMENT 304 E WEBER AVE-3Y'Fl.-STOCKTON CA 9$202 <br /> NON-REFUNDABLE PERMIT CALL <br /> /N 209 953-7697 FOR INSPECEEONS EXPIRES 1 YEAR FROM DATE ISSUEDJ-Gy <br /> JOB ADDRESS ztAj I��. _ CITY/LIP 5-►p -�-t� -Zps v <br /> 2 p d <br /> CROSS STREET �t�iV}SUN T��f'C. (APN f>�- �(] PARCEL SIZE 6,C) (C C , a <br /> OWNER NAME. DIJYI_ C.��� C C �GC�t I� G{ �� ll.�{�y` utoNEA <br /> OWNER ADDRESS �Z(]� y(,STATFJZIP j* 0 'b <br /> CONTRACTOR C11 N' F /ys�r 1 t f�SSO C 1331 ul2 <br /> PHONE <br /> CONTRACTOR ADDRESS s' CITY/STATE/LIP <br /> LICENSE ❑C-02 ❑C-36 OTHER_ NUMBER EXPIRATION DATE <br /> WATER TABI.F.DEPTH: _ ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> FW PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# PN-D - <br /> TVPF.OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION LJ ENGINEER DESIGNED(ALTERNATIVE <br /> ❑ REPLACEMENI ❑ DESTRucr1GN <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL .l OTHER <br /> NUMBER OF LIVING UNITS: NCMBER OF BEDROOMS: NUMBER OF EMPLOYEES' <br /> ❑ SEPTIC TANK TYPF/MrG _ CAPACITY_ gal #OFCOMPARTMENTS <br /> U CREASE TRAP TYPE/MFG _ CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WFI.I, _ _ ft FOUNDAIION R PROPERTY L[NF._ ft <br /> LIFT STATION SIZE_ TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #GF LINES--. LENGTH OF LINES____ __ft <br /> DISTANCE.TONEAREST WELL it FOUNDATION ft PROPERTY 1.INE ft <br /> ❑ FILTER BED WIDTH R LENGTH _ R DEPTH_ fi <br /> DISTANCE TO NEARESTWELL ft FOUNDATION _ft PROPERTY LINE $ <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE _ ft <br /> ❑ SUMPS WIDTH _ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WFI.I. ft FOUNDATION ft PROPERTY LINE__ R <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE_ R <br /> U SEEPAGE PITS NUMBER WTDTH tt DEP'T'H ft <br /> DISTANCE TO NEAREST WELL _ ft FOUNDATION tl PROPERTY LINE it <br /> I HEREBY CERTIFY THAI'1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,Sl At E LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> IN'IMU: OUR ADVANCE NOTICE:RF.Qt11RED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED ZL TITLE CItZ1f UIL�I�� DATE <br /> V I <br /> r w <br /> 2T 1 <br /> .. <br /> p i <br /> /2 ba NVR NI U E <br /> S•IS ? _ H - <br /> n1 n t <br /> j DEPARTMENT IL F,9NLY 2 <br /> Application Accepled By _ L'�-� _ Date 6 3(OS Area employee Ill# <br /> Final Inspection By_ ` ,� _ Date _�S� ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: __ Pit/Sump Soil Character; <br /> COMMENTS P..11��AAu gtL, .Ill _.SMLIC • 3 s l I n.' _ AA10 <br /> o_ pe,5j z�t�rorat�tiy, f�ui C dean ..�1! G�ei <br /> PF, SC Received 'hcc Amount Dale Permit/ <br /> I Cade I%rn By Cash Rcmitled / Service R uest# Invoice# Permit ID# <br /> 6 <br /> �L.zz Szf ? 9 3.cc7 9 0 S9P D <br /> 42-o2-001 ONSITE WASTEWATER PERMIT <br /> 12/2212013 r7 fn s,. ,.- f - <br />