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ONSITE WAS .WATER TREATMENT SYS M PERMIT,` �k <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER._ -3"°FL STOCxTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(2n 953-7697 FOR INSPECTIONS EXPIRESfli-y ern:RrFROM DATE ISSUED <br /> JOB ADDRESS ° I r <br /> CITY/ZIP 4e'' �'v <br /> CROSSSTREET /� +" APN r .55P RCELSIZE�30' 4 9 r <br /> OWNERNAME _ G��t+� /J.G'l �I(!� fP' PHONE <br /> OWNER ADDRESS CITYISTATE/ZIP <br /> CONTRACTOR PHONE~ a. <br /> CONTRACTOR ADDRESS Oz-z--7 CITYlSTATEIZIP ''�' /'�•�, "� <br /> LICENSE C 2 ❑C-36 OTHER NUMBER EXPIRATIONDA Y s.F: <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X *i <br /> W <br /> ❑ PERC TEST # BUILDING PERMIT# -61 q019YJLAND USE APPLICATION <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAiRIADDITION ❑ ENGINEERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT- ❑ DESTRUCTION �• <br /> INSTALLATION WILL SERVE: Ao+JRrSIDENCE ❑ COMMERCIAL © OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: _. - �^ NUMBER OF EMPLOYEES: <br /> J rj�� <br /> SEPTIC TANK TYPE'/MFG��F !�� CAPACITY 2,— © gal #OFCOMPARTMENTS <br /> � <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS N <br /> ❑ PKG TX PLANT DISTANCETO NEAREST: WELL ft FOUNDATION ft y;PROPERTY,LINE _ R <br /> RP = 3 <br /> ❑ LIFT STATION SIZE TYPE OP PUMP 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ny, <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH oFLINES" _ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION /p ft PROP RTY LINE'~" ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPT}{ $ y <br /> r <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH.,;;t � ":._` ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LHVE:x ft ag. <br /> ❑ SUMPS WIDTH ft LENGTH ",, f �t %'=,;' <br /> R DEPTH:�w��i+: <br /> "= " ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE'``A ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ti n�*X`•k r <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY.LINE,z R <br /> SEEPAGE PITS NUMBER -1";e— WIDTH J _ft DEPT}{ f� ;ri,s ft y <br /> DISTANCE TO NEAREST WELL ft FOUNDATION � jl)I2- ft PROPERTY LINES <br /> a,> <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATF LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY �I e`' � ? <br /> r j <br /> MINIMUM R ADV E NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(249).453-17697 " <br /> TITLE 11. <br /> SIGNED / I F <br /> z <br /> DATE •�J , <br /> b b YCI AL <br /> 77 <br /> s-11 t4ty : <br /> b V s <br /> S 1 NT 1- - r <br /> o �+ f x -7r a aJ <br /> 7: fr <br /> 44 <br /> ri I 1 <br /> 771 ,ry <br /> DEPARTMENT USE ONLY <br /> Application Acce a Date Area `Y mployee ID# <br /> Final Inspection Date ❑ SPECIAL PERMIT;.Approvewd by p. <br /> Character of Soil to pth of Ft: Pit/Sump Soil Character: * <br /> COMMENTS <br /> PE SC Received Check#/ Amount Permit) <br /> Code INFO B Remitted Date Service Request# Invoice:#i rnf ,`, Permit 1D# <br /> t►T// �/ /tJ�is� C� � � '" � dx�''4:,f - <br /> 42-02-001 N. <br /> »-, ONSITE.WASTEWATER PERMIT <br />