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ONSITE WASXEWATER TREATMENT SYS <br /> '�EM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> ARTMENT # 304 E WEBEA� <br /> NON-REFUNDABLE PERMIT -3"FL-STOCKTON CA 95202 - (209)468-3420 <br /> CALL(209)953.7697 FOR INSPECTIONS <br /> EXPIRES i YEAR FROM DATE ISSUED <br /> JOB ADDRESS r 7 <br /> CITY/ZIP <br /> CRDSS STREET <br /> OWNER NAME 1 9' PARCEL SIZE U{- <br /> OWNER ADDRESS JPs} >4 2?_Y PHONE- Ig�— e'ff4 <br /> CONTRACTOR <br /> �� CITY/STATE/ZIP � <br /> /1' ( � <br /> i <br /> PHONE <br /> CONTRACi'OR ADDRESS <br /> _ CITY/STATFJZIP <br /> LiCENSE C-42 ❑C-36 OTHER <br /> WATER <br /> NUMBER EXPIRATION DATE 1!1 <br /> TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X 1 <br /> ❑ PRC TEST # Y f! <br /> BUILDING PERMIT# LAND USE APPLICATION# +j <br /> TYPE OF WORK: Li I;W INSTALLAT[ON <br /> REPAIA/ADD[TION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT <br /> EI DESTRUCTION <br /> INSTALLATION WILL SERVE; RESIDENCE 1 <br /> ❑ COMMERCIAL ❑ OTHER ! <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br /> NUMB <br /> SEPTIC TANK TYPE/MFG ER OF EMPLOYEES: <br /> ❑ <br /> Ll CREASE TRAP TYPE/MFGCAPACITY gal #OF COMPARTMENTS <br /> CAPACITY, gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL <br /> R FOUNDATION ft PROPERTY LINE ft <br /> El LIFT STATION SIZE TYPE OF PUMP <br /> ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES 1 _ LENGTH OF LINES F ` <br /> DI STANCE TO NEAREST WELL��,4 ft FOUNDATION___7 ft PROPERTY LINE I� ��' ft 1 <br /> LlFILTER BED WIDTH ft LENGTH ft DEPTH <br /> ft <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE g <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH f� <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft' PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> © DISPOSAL PONDS WIDTH ft. LENGTH R DEPTHft ? <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER I WIDTH ft DEATH 'L7 <br /> DISTANCE TD NEAREST WELL_- 16,/,�A ft FOUNDATION ft PROPERTY LINE d r+ ft <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 /> MINIMUM 14 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS ) <br /> LEASE CALL(249)953-7697 <br /> SIGNED ' TITLE Gz� ✓ DATE ` <br /> V. <br /> J <br /> 41—efIll <br /> tA <br /> 1 . <br /> �l <br /> h <br /> 4 <br /> F I- <br /> 1, <br /> ti <br /> tiR <br /> ## <br /> F <br /> 4 <br /> DEPARTMENT US ON F <br /> Application Accepted By Date Area Employee ID# <br /> _ <br />-,"Final Inspection By - �' ---- Date !� �� -" - —❑-SP IAL PERMIT=Approved 6y =. <br /> Character of Soil to De RY43 Ft: _ Pit/Sump Soil Character: <br /> COMMENTS <br /> PE uR(�eat,� Chec Amount Permit/ <br /> Code IN B ash Remitted Date Service Request# Invoice Permit ID# <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />