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ONSITE WA'�WATER TREATMENT SYS�i PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH..APARTMENT 600 E[YIAIN STREET-STOCKTON CA 95202-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS �ExPIRES I YEAR FROM DATE ISSUED JOB ADDRESS 2677.7 -6 MAri-rbc it CITY/ZIP CROSS STREET SY` 1^� APNtt �I > / PARCEL SIZE -/7 9!CS C r / O OWNER NAME 6[_t L C') PHONEC �) 23`1 `?1 Z (Q P OWNER ADDRESS 46pmc' res ?7rPsa CITY/STATE/ZIP CONTRACTOR PHONE 17 CONTRACTOR ADDRESS CITY/STATE/ZIP 1( - ' LICENSE ❑ C-42 0 C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X y © PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# ; TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ' ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE O COMMERCIAL © OTHER I NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG C"((S T-7 CAPACITY gal #OF COMPARTMENTS 0 GREASE TRAP TYPI:IMFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft 0 LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) D LEACH LINES O LEACHING CHAMBERS #OF LINES LENGTH of LINES ft DISTANCE TO NEAREST {WELL ft FOUNDATItON ft PROPERTY LINE ft IY FILTER BED WIDTH ! ft LENGTH ft DEPTH ft DISTANCE TO N16MST WELL I 1 ©)p f FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTI�` � ft DEPTH ft �] DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft O SUMPS WIDTR ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION _ ft PROPERTY LINE ft D DISPOSAL PONDS WIDrfl ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft \\ ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. p MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGN I' TITIX P4 DATE {.0 - I 1-4 I -� S N O Q IN O N L07 Ep - - - - _ _..... DEPARTMENT >a ONLY � Application Accepted By 4 Date Area Emp toy ee ID# S Final Inspection By Date A C © SPECIAL PERMIT-Approved by Character of Soil to Di'66 Ft: P' Sump Soil Character: COMMENTS C.(,/ "7-o IF ,e. fir? _ � 0-7-a2[ irs¢ 6 PE SC Received Check#/ Amount Permit/ Code INFO By Cash Remitted 2Date nnService Request# Invoice# Permit ID# G� ��5 231,.0--) i2d 0 1.5F 15i 42-01 W*�7�f�-E w ' j �- I — ONSITE WASTEWATER PERMIT nennnnn� '