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1 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3.n FL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1 o�S , , R#,P— C <br /> D _ <br /> ' 1Tl'IZIP pi <br /> Q S <br /> ---, �'��� _ PARCELSIZE Y-"'�. C- 1 y <br /> CROSS STREET AIN ��� 40-� 1 V �f 1 t <br /> 0WERNAME 1`-���IvnPl �� -!t i_�tiv(✓ PHONE <br /> OWNER ADDRESSC�ITYI�STATFJZIP <br /> r CONTRACTOR '��F-k PHONE` <br /> L CONTRACTOR ADDRESS ISSL N 1=?"IC��V W 1"���/'� �7/ CITTVVISTATE/ZIP <br /> � CI <br /> 1 LICENSE -42 C-36 OTHER NUMBER sci� e EXPIRATIONDATE d C�Z3 IJJ� <br /> WATER TABLE DEPTH; A GEOCRAPHICALINFORMATION; Coordinates X y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: 46 NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNEDIALTERNATIVE <br /> ' ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: }� RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: /1�pI NUMBER OF BEDROOMS: ct !- NUMBER OF EMPLOYEES: <br /> 6 '�- <br /> IIF SEPTICTANK TYPFIMFO -P4 L- CAPACITY 00 g21 #OF COMPARTMENTS- <br /> L3 GREASE'TRAP TYPE/MFG, CAPACITY gal #OF COMPARTMENTS <br /> 1 r I f <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST; WELL �a ft FOUNDATION 4C) ft PROPERTY LINE n <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES Od LEACH IN'GCHAMBERS <br /> #OF LINES '7 LENGTH OF LINES <br /> 1 / <br /> DISTANCE i0 NEAREST WELL !Q G7f f" ft FOUNDATION ` O fl PROPERTY LINE <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> y DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH n <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE III <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TOr NEARESTrWELL ft FOUND(A,T N ft PROPERTY <br /> YY7LINE ft <br /> 18 SEEPAGE PITS WIDTH _A -Amomm I / i 0! DPPTH 6-45 1 ft <br /> 4 DISTANCE TO NEAREST WELL V50 -V A FOUNDATIONIoG�/ f[ PROPERTY LINE 7S/`} ft <br /> CCC I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 1 IMUM 14 HOUR ADVANCE NOTICE REQUIRED FORINSPECTION.S-PLEASE CALL(2091953-76q7 FF <br /> SIGNER ... ..-,-_-- TITLE DATE G �3 <br /> -- '---— -.... .------------ - <br /> { <br /> IA1 I I <br /> Ir <br /> 1 �- <br /> f <br /> ` 7i <br /> II <br /> k <br />