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ONSITE WASTEWATER TREATMENT SYSTEM PERMITS <br /> -AN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E WEBER AVE —3""FL-STOCKTON CA 95202 (204)4 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS <br /> g. <br /> EXPIRES I YEAR FROM DATE ISSUED <br /> OH ADDRESS <br /> O�J C[rYIZ,P F v� <br /> :;ROSS STREET �. y L� ?� p� <br /> kf APN 40 10 M', <br /> WNEP-1 � <br /> .R NAME � J PARCEL SIZE }O O'. <br /> d <br /> PHONE <br /> r�lWNE <br /> R ADDRESS y <br /> CITY/STATE/ZIP <br /> I -ONTRACTOR / - S �1 L =— <br /> PHONE <br /> �ONTCTOR ADDRESS O / f <br /> !!!!!! CITY/STATE/ZIP a, C LA J f 3^ <br /> .ICEN'SE ❑C42 ❑C-36 OTHER ZOO <br /> NUMBER 1 �- S 3 EXPIRATION DATE / J6-7 <br /> ATER TABLE DEPTH: 0 GEOGRAPHICAL INFORMATION: CDordi,,ate5 X <br /> .Fit PERC TEST(S) NUMBER Y <br /> LAND USE APPLICATION# <br /> PYPEjOF WORK: 2 NEW INSTALLATION <br /> ❑ REPAIR/ADDITION <br /> El REPLACEMENT ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> F <br /> + <br /> � iSTALLATION WILL SERVE: ❑ DESTRUCTION <br /> � RESIDES <br /> 'I - NCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: _ NUMBER OF BEDROOMS: --S <br /> NUMBER OF EMPLOYEES: <br /> I SEPTIC TANK TYPE/MFG <br /> �o•�(�C C CgpgC1TY QJ gal 9 OF COMPARTMENTS <br /> GR EASE TRAP TYPE/MFG <br /> CAPACITY gal #OF COMPARTMENTS <br /> 1 PKG TX PLANT DISTANCE TO NEAREST: WELL ( -7 <br /> —�2 f2 FOUNDATION ` ft PROPERTY LINE :3 � <br /> s LIEF STATION SIZE ft <br /> + s TYPE pF PUMP Ell SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 7 LEACH LINES 4EI LEACHING CHAMBERS L`Q2, #OF LINES LENGTH OF LINES p +✓ ft <br /> FILTER <br /> TO NEAREST WELL ft <br /> FILTER 8ED WIDTH FOUNDATION f ft + <br /> _—1�, PROPERTY LINE_L� ti <br /> `.� ft LENGTH <br /> R DEPTH - ti n li <br /> DISTANCE TO NEAREST WELL ft FOUNDATION <br /> i`'. MOUNDED WIDTH R LENGTH ti PROPERTY LINE ft <br /> h tl DEPTH fi d;. <br /> J DISTANCE TO NEAREST WELL fl FOUNDATION <br /> ] SUMPS WIDTH ft PROPERTY LINE <br /> fi LENGTH <br /> fl DEPTH B <br /> DISTANCE TO NEAREST WELL FI FOUNDATION <br /> l DISPOSAL PONDS WIDTH ft PROPERTY LINE fi <br /> f� LENGTH Ft DEPTH <br /> DISTANCE TO NEA REST WELL — 1't <br /> � FOUNDATION ft PROPERTY LINE <br /> ( SEEPAGE PITS WIDTH tY LENGTH <br /> t ft <br /> fl <br /> DISTANCE TO NEAREST WELL fl FOUNDATION <br /> A PROPERTY LINE R <br />[ <br /> HEREBY <br /> CERTIFY THAT 1 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 /> MINIMUM I4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE;CALI,(209)953.7697 <br /> CNEDi <br /> F TITLE lam/ DATE f ---'r3 'r 3 <br /> tt <br /> 3 <br /> f <br /> k .. <br /> i <br /> J) ,. <br /> I <br /> I <br /> � t <br /> V <br /> F <br /> a <br />