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ONSITEWASTIEWATER TREATMENT SYSTEM PERNT <br /> SAN JCAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT _CIALL(20,9)953-7697 FOR INSPECTIONS ExPIRES I YEAR FROM DATE ISSUED' <br /> joB ADDRESS <br /> 5 <br /> CROSS STREET W APN PARCEL SIZE <br /> OWNER NAME PHONE <br /> OWNER ADDRESS <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESSY/STATEIZIP <br /> ----------- <br /> CIT <br /> I. <br /> LICENSE FIDC-42 EIFC-36 OTHER_ NuMr3ER� _EXPIRATION DATE, <br /> V/ATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates y <br /> 0 PERC TEST LDING PERMIT LAND USE APPLICATION <br /> TYPE OF lAIORK: NEW INSTALLATION !--I REPAIRIADDITION u ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT i DESTRUCTION <br /> il OUT-OF-SERVICE SEPTIC SYSTEM <br /> INSTALLATION VVILL SERVE: VI—RESIDENCE F COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUM13EFZ OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG J—CAPACITt2�V-�-26eW g,11 #OFCOMPARTMENTS <br /> GREASE TRAP TYPE/MFG CAPACITY gq I ft OF COMPARTMENTS <br /> DISTANCE To NEAREST: WELT 1VIA It FOUNDATION ft PROPERTY LINE ft <br /> LIFT STATION SIZE /) J71 <br /> )4. TYPE OF PdM!"' r� PKG TX PLANT 2 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES 1-1 LEACHING CHAMBERS #OF LINES, LENGTH OF LIMES <br /> DISTANCE To NEAREST WELL ft FOUNDATION <br /> ft PROPERTY LINE ft <br /> Q FILTER BED IAIID-1-1-1 ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SUAFiPS WIDTH ft LENGTH fl, DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft. <br /> DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION _ ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER ,6 VVIDTH--Llft DEPTH ft <br /> DISTANCE TO NEAREST WEI-L,4,Z/,d, 2j_ ft FOUNDATION —ft PROPERTY LINE ft <br /> ,1- 7--- - <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SANJOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> -IONS <br /> 4 U of NOTICE RE UIRED FOR INSPEC7 PLEASE C&L-LQ-769'7 <br /> a.09),0 - <br /> SIGNED TITLE tDATE <br /> 30 JsTy <br /> -ttl ME <br /> F-INSO' psa�AEKT <br /> I—Vc-n i <br /> 04== <br /> E P A R T M E N T U S E 0 ft'L Y <br /> Application Accepted By0-7 Date J!�/47QJCfArea Employee ID11 5,,, <br /> Final Inspection By_ im Date bPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/SUmp S ',I Cra <br /> hacter: <br /> COMMENTS 4 K/ 5"+1 C ,�rl C,I- OL� e- r <br /> f IlL J <br /> E S Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO 3 _Cash Remitted Service Request t L, <br /> +2-M T5 -3 "-C AA--0 <br /> 42-n 1 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 411411, e'ssvx-3- <br />