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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> 5 .AQUIN COUt';;;�!VIRONMENTAL HEALTH DEPARTMENT y WEBER AVE-3M°FL-STOCKTON CA YSLUL - (209)46$-3420 <br /> NON-REF ' R IT qALL{209 9 -7b97 FoR IN$`SP- NS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �.j'/� I',tk''�} i(� ((j - <br /> - CROSS STREEF T J[/V tLIE �1-'vaw[[ APNDI-7-!tel LJ- I V- _ ___ PARCELSIZE r tp <br /> OWNER NAME PHONE 31 <br /> J <br /> y Qr}�- <br /> J OWNER ADDRESS 60 G�N�A �' CITYISTATEIZIP t/�p f vrr�' �� <br /> 11 <br /> CONTRACT �r�� t 1"�1� sV PJION V ) 6`'' [/t (/1t��"� <br /> 1 CONTRACTOR ADDRESS I v ' ,W VVS a �r v r - ___ r,CIITY/YlS4TATE/ZIP-. L c16p--1s{1 /) a2'M N <br /> LICENSE C-42 ❑C--36 ^ OTHER NUMBER �OV`-+1 E%PI RATION DATL 1`( D 3 �` <br /> j WATER TABLE DEPTH:_ 1�'1 H GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 1 0 PEAC TEST($) NUMBER LAND USE APPLICATION# �/ <br /> -- TYPE OF WORK: NEW INSTALLATION ❑ REPAIRlADDITION� }3 ENGINEER DESIGNEDIALTERNATIVE <br /> { ❑ REPLACEMENT EI DESTRUCTION <br /> i INSTALLATION WILL SERVE: 0 RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF Ltvm&UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> M� SEPTIC TAN PEINIFGV,t L.� - CAPACITY $al tf OF COMPARTMENTS <br /> 14 GREASE TRAP TYPEIMFG CV CAPACSTY gal N OF COMPARTMENTS <br /> 0 PKG TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION H PROPERTY LINE R <br /> fl <br /> LIFT STATION SIZE--Gtl TYPE OF PUMIMEN(rn � ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS'—"�I'��y' \ J II OF LINES Lr LENGTH OF LINES 4L R <br /> L5. <br /> .. .. - <br /> DISTANCE TO NEAREST WELL rr' FOU <br /> NDATION R PROPERTY LINE fl <br /> Dlsr c LYt�1 <br /> t ^ <br /> FILTER BED WIDTH-+0 R `LE�NNGTHt f1 DEPTH 2 MAAd A <br /> DISTANCE TO NEAREST WELLSl FOUNOATION�LO - R PROPERTY LINE S H <br /> ❑ MOUNDED WIDTH A LENGTH fl DEPTH ft <br /> q. DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH R LENGTH H DEPTH A <br /> DISTANCE TO NEAREST WELD R FOUNDATION R PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH A <br /> DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTY LINE R <br /> PITS WIDTH R LENGTH ft DEPTH H <br /> SEEPAGE ��ff,,�� ��yea /�'� <br /> DISTANCE TO NEAREST WELLM 0*10 R FOUNDATION FCJ ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE.PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> 1nI�rT STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> L i ,, I . <br /> - - SIGNE�1rNl� MINVM O�ADVANCE NOTICE REQUIRED FOR iAl&� ON ALL(109)953-7697 <br /> 15.8 T <br /> Jul <br /> . S y <br /> FAIA8U HInECUNN <br /> IVTAI fIr,11 t I <br /> 61.7 <br /> DEPARTMENT USE ONLY <br /> 1 Application A cepled B Date!�r�/� (_—n Arra Frnploycc I D*-57:�305/ <br /> Final Inspection Date�yp[jL ❑ SPECIA ERMIT-Ppproved 6y <br /> .� Charecter of Soil to Depth f 3 Ft: PIIISDmp Soil Charade &,.:; <br /> COMMENTS <br /> �O Av <br /> Aj <br /> PE Sc Rece" ed Is Amount Permit! <br /> Code INFO $ ash Remitted Dale Service Request tl Invoice q Permit IDN <br /> 42-01-00t <br /> -22M2 � /���„�� +Z/ ✓ a f ONSITE WASTEWATER PE MIT <br /> j <br /> ` t � <br />