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Pt� <br /> ONSITE WAST'�)ATER TREATMENT SYSTF i PERMIT 6 Q Za YS/s"' <br /> SAN JOAQUIN COUNTY ENVIRONNIENTAL HEALTII DL; .FNIENT 304 E WE13ER A% 3""FL-STOCKTON CA 95202 - (209)46-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FRom DATE ISSUED <br /> JOB ADDRESS ^- �r�.� Z- Crrv/ZIP <br /> f-t <br /> CROSS STREET `���"��- APN V� I~5 i O_'� L PARCEL SIZE <br /> 4 <br /> 0 <br /> i <br /> OWNER NAME \ PHONE <br /> k �!^^^OWNF.RADDRFSS ���/ "" CITYISTATE/ZIP <br /> CONTRACTOR �zToAl PHONE [{7 l/rf�l✓ <br /> Ili <br /> CONTRACTOR ADDRESS <br /> (r-, �y`VA • �f�. p�[C�I�T{YISTATEIZ.IP <br /> LICENSE: r"•42 ❑C-36 OTHER NUMBER `I 7 Y z[ �� ExPIRATION DATE / <br /> WATER TABLE DEPTn: 100 T"" ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(5) NUMi3ER LAND USE APPLICATION# <br /> YPE OF WORK: NEW INSTALLATION ❑ REPAIRIADDITION C] ENGINEER DESIGNED/ALTERNATIVE <br /> FT <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: /ff-RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: ! NUMBER OF BEDROOMS: J NUMI3£R OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG[.fit __ _ CAPACITY /(p�`�� gal #OF COMPARTMENTS �{ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> i � I <br /> pr❑ PKG.TX PLANT DISTANCE TO NEAREST: WELL /1.70 ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE Oi.PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> � <br /> F- <br /> 10 <br /> LEACH LINES ULEACHING CHAMBERS l'sL(�� � #OF LINES -- LENGTH OF LINES � <br /> t DI STANCE TO NEAREST WELL �OC1 r"t- ft FOUNDATION /a t ft PROPERTY LINE 'f-' ti <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft . <br /> $ DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DzPTH its <br /> DISTANCE TO NEAREST WELL It F 1NLATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> Di STANCE TO NEAREST WELL ft FOUNDATION tt PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH_ tt <br /> Gr-SEEPAGE <br /> DISTANCE TONEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> PITS WIDTH 7� €t LENGTH ft DEPTH - S tt <br /> I` DISTANCE TO NEAREST WELL /So ft FOUNDATION lZ> ft PROPERTY LINE `, ft <br /> t [HEREBY CERTIFY THAT[HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> & STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> N1 INIMnN 24}TOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 C� 7 <br /> ! SIGNE�! TITLE DATE <br /> I <br /> N. <br /> Ej <br /> r <br /> IL+ 1 <br /> _ Y <br /> I" <br /> I I L <br /> 47 <br /> Il' <br /> O fer c <br /> 1 � r <br /> vJ AI IIF; <br /> 1 <br /> t <br />