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ONSITE WASTEWATER TREATMENT SYSTEM PE 1VN[' <br /> SAN JOAQUn4 COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 EWESER AVE-3"°FL-STOCKTON CA 95202� 9)468-3420 <br /> NON-REFUNDABLE PERMIT pp CALL(209)953-7697 FOR INSPECTIONS -yFXPIRES 1 YEAR PROM DATE ISSUED <br /> JOBAPDRESS •2-'A 1?f CITYIZIP 1 I\OY` (7Y — <br /> �J <br /> CROSS SZ'RF.ET <br /> APN��1 )-1�- eq-114I0WARCEL SIZL C <br /> OwneuNAAIE Tl AY v � I O PHONE <br /> OWNER ADDRESS CTTYlSTATEJZIP _ <br /> CONTRACTOR PHONE <br /> r <br /> CONTRACTORADDRESS 1 CTTS'!ST'ATFlZIP ! <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GROGRAPHICALINFORMATION: Coordinates X Y <br /> PERC TEST # J BUILDING PERMIT# LAND USE APPLICATION# 1 <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIPJADDmON ❑ ENGINEERDESIGNEDIALTERNATTTE' <br /> ❑ REPLAcFmENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: Q RESIDENCE ❑ CGIAMERCIAL ❑ OTrIER <br /> NUh1BEROF LIVING UNITS: NUMBER OP BEDROOMS: NUMBEROF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPUMFG - CAPACITY gel #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gel N OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISPANCETO NEAREST: WELL fl FOUNDATION ft PROPERTY LINE H <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES Q LEACHING CHAMBERS #OFLINES LENGTH OF LINES A <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ FILTER BED WIDTH it LENGTH fl DEPTH fl <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH ft LENGTH fl DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH R LENGTH fl DEPTH ft <br /> DISTANCETO NEAREST WELL fl FOUNDATION It PROPERTY LINE fl <br /> Q DISPOSAL PONDS WIDTH ft LENSTR It DEPTH A <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ SEEPAGE PITS NuaIEER WIDT11 R DEPTH It <br /> DISTANCETO NEAREST WELL ft FOUNDATION R PROPERTY LINE fl <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 /> MINI MUNI 24 HOUR ADVANCE NOTICE REQUIRED FORINSP CTION5-PTE SE CALL(2U9)953-7b97 n (� <br /> SEGHF. TITLE Vt DATE �� <br /> g k7 <br /> O <br /> 0 <br /> O <br /> 1 - 3 S -❑ <br /> is <br /> 7 <br /> (711 <br /> p4 <br /> A I C LINTY <br /> I ! N RCN E A1.. <br /> TE ENT <br /> V <br /> DEPARTMENT USE ONLY <br /> Application A .Hy Date "'✓/"� A. Employee]D# <br /> Final fnspecl B Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to De b ora Fr. Pit/Sump Sell Character: <br /> COMMENTS111 41 <br /> `-Y% <br /> PE SC Received Check# Amount Date Permit/ invoke# Permit ID$...• <br /> Code INFO B ash Remitted Service Request# <br /> 222 D �O0 ,3 3 <br /> 42 02A01 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />