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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> N JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT \./ JOE E WEBER AVE-3y°FL-STOCKTON CA 95302 x/66#-3020 <br /> ON-REFUNDABLE PERMIT CALL 209 955-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM ?M ISSUED <br /> JOB ADDRESBy <br /> CITY/ZIP / x' <br /> toss STREET ( 1 ti All I I ) PARCELSIZC O <br /> a <br /> IMPHUR NAME t'I� � •'i.` PHONE 4 � <br /> UVAAWR ADDRESS .I CITV/STATE/ZU, \ e\ <br /> ornEACTOR ,^l. .i„ !1 PHONE <br /> L. <br /> COMMCTORADDREBS CITY/STATVZIP t : <br /> TENSE LI C42 ❑C-36 OTHER NUMBER EXPIRATIONDATE <br /> ITER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: CDOrdhlateT X Y -_ <br /> PERCTEST # BUILDINGPERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑, New INBPAIA.AT1pN ❑ REPAIWADDITION ❑ ENGINEER DESIGNEDIALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> STALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> ` NUMBEROF LIVING UNITB: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> I4 GREASE TRAP TYPFJMFG CAPACITY gal #OFCOMPARTMENTS <br /> 9 PKG TX PLANT DinANCEM14G Sf: WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION Sim TYPEOPPUMP ❑ SAND OIL SEPARATOR(ENcUAIRDSYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS It OF LMEB LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> MOUNDED wimm ft LENOTH ft DEPTH ft <br /> DIBTANCETONGREST WELL ft FOUNDATION ft PROPERTY LME ft <br /> ❑ SUMPS W. ft LENGTH ft DEPTH ft <br /> DurrANCETONRAREST WELL ft FOUNDATION RPROPERTYLWE ft <br /> 6. DISPOSAL PONDS W. ft LENGTH ft DEPTH R <br /> DISTANCETONEARFST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WIIITx ft DEPTH It <br /> DISTANCETONEAREST WELL ft FOUNDATION R PROPERTYLOIE ft <br /> ` I 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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-2697 <br /> GNED _.-_L^ TITLE \1 J- DATE <br /> 1 <br /> �iin our»a"Est L _—Y9KJb cougr <br /> C <br /> . `C <br /> C, <br /> .mM ne a . <br /> PARCEL <br /> :.PTLe <br /> 1 <br /> 9I. i. <br /> �P1 <br /> FtE ii <br /> ( DE PARThIENT 11�E IT - -�A'�Eq AOO <br /> Application Accepted By Data C 2 r T Aree Emp7oyc9IDH N GUV l/G;i <br /> -iaalhospection By _ __ Dare._ ❑ SPECIAL PERMIT Approved by <br /> Jhaocter of Soil to Depth of 3 Ft: __ PiDSomp Soil Character: <br /> COMMENTS - - - -- <br /> PE SC Reeelved i Amount Do_ - Permlcl Invoice# Permit ITNJ - <br /> Cade Ingo B Caah ReMded Service Re uert# <br /> 42.x1 $aI ', lfG-•riu !.' .�/L"(I� �{����•' <br /> ONSITE WASTEWATER PERMIT <br /> Isn2-02,001 <br /> I3 MO03 1, <br />