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ONSITE WAS' WATER TREATMENT SYSP"'SNI PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH D_%RTMENT 304 E WEBER A—-3k"FL-STOCKTON CA 95202 - (209)468-3420 <br /> KION-REFUNDABLE PERMIT CALL(209)'953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS Z5(gS I! S, J�/l Pt�TI-k � CITY121P � I <br /> 3 <br /> T� 3 j <br /> CROSS STREET J-CJ APN �� t✓ A Ii O <br /> ZE <br /> OWNER NAME t.,iw 066 -Dty [ eft., .. PHONE ID 9 <br /> OWNER ADDRESS �� I <br /> ,t, �, CITY/STATEIZIP <br /> CONTRACTOR N SNC, PHONE <br /> CONTRACTOR ADDRESS ISS I':; , Dklu>uJ ke E, CITY/STATE/ZIP <br /> LICENSE 114 C-42 ❑C-36 `:! OTHER NUMBER f Sg5,q[J EXPIRATION DATE 0 0 S <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> Y <br /> ❑ PERC TEST(S) NUMBER LANA USE APPLICATION# <br /> TYPE OF WORK: 00 NEW INSTALLATION ❑ REPAIR/ADDITION <br /> ❑ ENCINEERDESIGNEDIALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE �d0(Iy MERCIAL HERB JZ <br /> NUMBER OF LIVING UNITS:_.k .Z NUMBER O BEDROOMS: NUMBEffO MPt�OYES:r <br /> 'IM I <br /> SEPTIC TANK TYPEIMFG ,�� � r�(r CAPACITY I D Q gal #OF COMPARTMENTS 2- <br /> LJ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS , <br /> L3PKG TX PLANT DISTANCE TO NEAREST: WELL t ft FOUNDATION LSr-F ft PROPERTY LINE 17 <br /> I ft <br /> L3LIFT STATION SIZE TYPE OF PU _ ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ® LEACHING CHAMBERS 3S, <br /> 3 #�AT <br /> LINES LENGTH OF LINES }t <br /> DISTANCE TO NEAREST WELL r ON ftPROPERTY LINE \ <br /> r , tt <br /> FILTER BED WIDTH ZO ft LENGTH ft DEPTH <br /> ft <br /> DISTANCE TO NEAREST WELL I001-f ft FOUNDATIONt*O { ft PROPERTY LINE 2-c> } <br /> 11 <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <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 ft { <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH }t <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS WIDTH 11 ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE <br /> DATE_Q6102_10 3 <br /> FF +. ,i <br /> r <br /> i A0 I 1 211 -Ar I I N� <br /> ;j <br /> UI C - <br /> G7 IiBL C H A jj <br /> ti SI I <br /> a <br /> Plz7r=F, <br /> 171-9 <br /> _. <br /> 14 7 2 I, <br /> .41 <br /> DEPARTM FNT USE ONLY <br /> Application Accepted.BY. _. �' t .: Bate ^"-- <br /> �,. Arcaf�I Employee ID# <br /> Final inspection By Date 6 IS ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of Ft: Pit/Sump Soil Character: ! <br /> COMMENTS •, •. � <br /> PE SC Received Check#/ Amount Date Permitl <br /> Code INFO B Remitted Service Re uest# Invoice# Permit ID# <br /> 10 ��3Yc7 31 <br /> 42-01.001 <br /> Iaq 3 5rn � f <br /> 1212102 1 JL 933 ���',c�'y" <br /> 5 /1%9Ln ' / ONSITE WASTEWATER PERMIT <br />