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ld�jD ONSITE WASTEWATWTREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1 600 E MAIN STREET-STOCKTON CA!�(209)468-3420 <br /> NON-REFUNDA L(299,.�3 b97 FOR INSPECTIONS EXPIRES 3 YEAR F SUED <br /> Jim ADDRESS CITY/ZIP. `, <br /> CROSS STREET �� �11'90 � APN PARCEL SIZE �`2-5 p 05 <br /> u <br /> DWNERNAME 1�RJ � l� PHONE 05 <br /> OtV'NER ADDRESS 31n <br /> f -514 � C1TYISTaTE1ZIPC,J�I`/CONTRACTOR VHONEWZ RM I � <br /> CONTRACTOR ADDRESS 1� CITYlSTATE/ZIP <br /> LICENSE A C-42 13C-36 OTHER�- NGMBER�EaPIRATION DATE fj`y <br /> 1,07 <br /> WATER TABLE DEPTH: ft CEOGRAPHICALINPORNIATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 0 NEW INSTALLATION 15r <br /> REPAIRIADDITION O F"NGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT 13 DESTRUCT/ <br /> INSTALLATION WILL SERVE: RESIbHNCIi ❑ COMMERCIAL - VVI <br /> NUMBER OF LIVING UNITS.—I - NUMBER OF BEDROOMS: -Iv OF <br /> ❑ SEPTICTANK Trp FG,.„, -�,Iniry CAPACITY gal #OFCOMPARTMENrs <br /> .I[3r ;w��� <br /> ❑ GREASE TRAP ,P F Y;_i f ECIAFTP,'_G+31 - ___ CAPACITY gal #OF COMPARTMENTS <br /> n FOUNDATION ft PROPERTY LINE ft-r�= <br /> CI LIFT STATION ;z ---TYPE Or PUMP —�-- Q PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 0 LEACHING CHAMBERS *or LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> © FILTERBED WmTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> �] MOUNDED WIDTH A LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST -WELL 1t FOUNDATION ft PROPERTY LINE ft <br /> 0 SUMPS WIDTH f[ LENGrH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft Q <br /> Q DISPOSAL PONDS WIDTH ft LENGTH fl DEPTH fl <br /> DISTANCE TO NEARF-S WELL ft FOUNDATION ft PROPERTY LINE ft 'u <br /> VSEEPAGE PITS NHMBERWIDTH ,} ft DEPTH 1t <br /> DISTANCE TO NEAREST WELL 1 ft FOUNDATION fi PROPERTY LINE 1t <br /> 1 HEREBY CERTIFY THAT I HAVE.PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> � Nl, 2 U V CE NOTICE REQUIRED FOR 1 S S-Pft <br /> L(209)953-7697()ja.�0 <br /> 7 <br /> SIGNE TITI. DATE <br /> r� <br /> , <br /> 7 <br /> i <br /> t <br /> L L I op I <br /> i� <br /> a - <br /> a <br /> DEPARTMENT <br /> SE ONLY <br /> Application Accepted Date 7 4- L' Area Employee 1D# <br /> Final Inspection i J Date �SPECIAL PERMIT-Approved bye—� - <br /> Character oFSoil to D of 3 IC Pit/Sump Soil ChSracter: -C•fcr•(l« j,.S <br /> COMMENTS 0u-tl L_ 7 OF r cr„� . .0: a c- r e 4 4c<;�✓1 L f rl e=H t r w S C, 'A& FY r C- <br /> i /'-a v'nS !J L C;i L r.v -A-6:.TU.i Trym� C; O/2 / r i S 4 rJ A£9 TV <br /> - <br /> PE SC Received _.Oheck#L Amount PermiU <br /> Code IyFO B Cash Remitted Da[!crService Re uest it ["voice M Permit IDI+ <br /> 4Z-01 ONSITE WASTEWATER PERMIT <br />