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i <br /> ONSITE WASTEWATIREATMENT SYSTEM PERMIT <br /> WEBER AVE-3""FL-STOCKTON CA 952'42._'(209)468-3420 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WE <br /> 1 <br /> NON-REFUNDABLE PERMIT )CALL(209)953-7697 FOR INSPECTIONS EXPIRES!! S�I YEAR FROM DATE ISSUED <br /> JOB ADDRESS ;� � ` Gl Ad CITYIZIP rTyr-,)�-LA - <br /> I�1 ..> �-y 4r'.it. PARCEL SIZE ."--f_l..C� Y . <br /> CROSS STREET APN �' 19`G� t- � - - <br /> OWNER NAME I 1 `-'��/`l� �I(. - PHONE y <br /> f OWNERADDRESS NIC <br /> \ ~�IL1fC,IJ(�f1��( � � ( 1�-``r1�`�{{L+�ik CITY'I7S'TATlE�IZFP •J� �ry _ <br /> CONTRACTOR �I\Ill \JY -7� {lih:Y�tt ; ^�� `'NU .1C',I1� `�, 1-.I' ( - PHONE 0-7`I��l C�^(,•-_ (j <br /> CONTRACTOR ADDRESS i.� T \ ISI 3l1 CITYlSTATEIZIP +. <br /> 1 LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> 'WATER TABLE DEPTIV ft GEOGRAPHICALINFORMATION: Coordinates X Y <br /> C,3�.PERC TEST # BUILDING PERMIT# LAND USE APPLICATIO\' <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED!ALTERNATIVE <br /> ❑ REPLACEMENT - - "0; DESTRUCTION <br /> F'#INSTALLATION WILL SERVE: CI RESIDENCE ❑ COMMERCIAL ❑ OTHER " <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: —77 <br /> Q SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> f❑ GREASE TRAP TYPFJMFG CAPACSTY. gal !f OF COMPARTMENTS <br /> © PKG TX PLANT DISTANCETO NEAREST: WELL 'f1 FOUNDATION -R PROPERTY LINE It <br /> 1 <br /> ❑ LIFT STATION SIZE TYPE OF PUMP - ❑ SAND OIL SEPARATOR(ENcLoSED SYSTEM) <br /> F1❑ LEACH LINES ❑ LEACHING CHAMBERS - #OF LINES LENGTH OF LINES R <br /> DISTANCE TO NEAREST WELL ft- FOUNDATION fl PROPERTY LINE- - ft <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH A J" <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH R LENGTH fl DEPTH ft J <br /> DISTANCE TO NEA REST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH - ft LENGTH ft DEPTH It - <br /> �! i <br /> DISTANCE TONEAREST WELL ft FOUNDATION ft PROPERTY LINE 11 <br /> P ]❑ DISPOSAL PONDS WIDTH fl LENGTH ft DEPTH n <br /> DISTANCE TO NEAREST WELL f1 FOUNDATION ft PROPERTY LINE ft <br /> Fj <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTHDISTANCE TO NEAREST WELL, ft FOUNDATION n PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCE$,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> y <br /> MINIMUM 24 HOUrAD�'ANCE NOTICE;REQUIRED FOR INSPECTIONS-PLEASE CALL(209I 953-7697 <br /> SIGNED!�I =._ 7'r'': >✓'Z� l -1..-:r• TITLE DATE <br /> ! / i 7.c 1 p I✓ . <br /> 31 rI <br /> f <br /> N E TA <br /> ! I LH E R M N - <br /> � 4 <br /> 77 <br /> ( 7K N,IfL <br /> DEPAk'fMENT USgj ONLY 1 <br /> Application Accepted By "j1 :=- - Date 12! 1 Area I Employee[DO <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by / <br /> Character of Soil to Depth of 3 Ft: Pi JSump Sail Character: <br /> COMMENTS <br /> PESC Received rr Check#!-.' Amount Permit! <br /> l_ .Date lm'olce# Permit lD# <br /> Code INFO B ash Remitted Service.Re uest to <br /> - - <br /> `i2. L{ <br /> J 42-02-001 - ONSITE WASTEWATER PERMIT <br /> 12!22!2003 <br />