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9�� <br /> ONSITE WASE"" _. NATER TREATMENT SY5 ~I PERMI <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALT.h_ -PARTMENT 304 E WEBER .,.E -3"°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 F•OR,INSPECTION'S EXPIRES I YEAR FROM DATE ISSUED <br /> JODADDRESS �G/ {33 ��' - --_- CIrYIZIP a�y(� J5 Zl1� <br /> ,5ff j �^g rn <br /> CROSS STREET ! APN I f V PARCEL SIZE ` d <br /> a <br /> z <br /> OWNER NAME 1� PHONE •- <br /> OWNERADDRESS 1 ' v CITY/STATE/ZIP <br /> CONTRACTOR ze PHONE <br /> CONTRACTOR ADDRESS 2_ CITY/STATE/ZIP <br /> LICENSEx-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# ' LAND,USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION 0 ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> h INSTALLATION WILL SERVE: 91<11ESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 01 <br /> 11 SEPTIC TANK TYPE/MFG� / CAPACITY � �J�� gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND-OIL SEPARATOR(ENCLOSED SYSTEM) <br /> b� l <br /> LEACH LINES ❑ LEACHING CHAMBERS #of LINES � LENGTH OF LINES �d ft <br /> DISTANCE TO NEAREST WELL „¢ ft FOUNDATION fd 4& ft PROPERTY LINE <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 DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> C] ''SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 6% <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER WIDTH2 ft DEPTH Z ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE Jr - ft <br /> 1 HEREBY CERTIFY THAT 1 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 /> MINIMU HOUR VANCE NOTICE REQUIRED FOR INSPECTIONS-,PLEASE CALL(209)953-7697 <br /> SIGNED <br /> TITLE J DATE <br /> r <br /> f <br /> � I <br /> 1 c`� <br /> r <br /> l PJ <br /> N 7 <br /> Zia - - <br /> DEPARTMENT USP ONL - <br /> Application Acceptc Dater� Area Employee lD# <br /> Final Inspection i Date ❑ SPECIAL PERMIT-Approve d 6y <br /> +. Character of Soil to Dep of 3 Ft; Pit/Sump Soil Character: l <br /> COMMENTS <br /> PE SC Received Che Amount Permit! <br /> Bate Invoice# Permit ID# <br /> Code INFO By Cash Remi ted Service Request# <br /> vlo Y-522 t I Lo& s s <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12l22I2003 1 <br /> 1 <br />