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ONSITE WAS' WATER TREATMENT SYST�l/I PERMIT <br /> SAN.IUAI?UIN COUNT}'ENVINON 14F.N'I'AL H4:Af,T11 D TMEN1' 304 E WI:BF:R AVF.'-3M'Fl.-STOC'KTON CA 9$202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT ALL(209)953-7697 FOR ISSPF.CTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> d06ADQRIES$ CITYILIP �j <br /> h/ Zb APN �� _�r -�06 _ Com. 2—.44C- <br /> OWNER <br /> .4C � <br /> CROSS STREET PARCELSIZE o <br /> OWNER NAME gxz, L�- PIIONE y <br /> OWNER ADDRESS y� ; TY ATEIZIP /' <br /> CONTRACTOR U� r f , PIIONE 4[f/ /*�� <br /> CONTRACTOR ADDRESS 00, U CITY/STATE/ZIP _TcL�LOClC C 5]y�"� <br /> LICENSE ❑C-42 ❑C-3b OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ,�J 11 GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST(S) NUMBER LAND USE APPLICATION# Nfr l f <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE fl <br /> © LIFT STATION SIZE TVP£OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS q of LINES LENGTH OF LINES li <br /> DISTANCE ToNEAREIT WELL 11 FOUNDATION fl PROPERTY LINE 11 <br /> ❑ FILTER BED WIDTH A LENGTH ft DEPTH 01 <br /> DISTANCE TO NEAREST WELL fl FOUNDATION A PROPERTY LINE R <br /> ❑ MOUNDED WIDTII 11 LENGTII 11 DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION tI PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 11 PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WmTH 11 LENGTH 11 DEPTH t3 <br /> Disl'ANCE,ro NEAREST WELL _ _ 11 1'0UNDATION :i 11 PROPERTY LINK <br /> ❑ SEEPAGE PITS WHr[v 11 LENUTIr-- 11 Di vrII ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION A PROPERTY LINE R <br /> I HEREBY CERTIF}'T T 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 /> %IIN OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 (� 3 <br /> SIGNED 7L TITLE �� DATE <br /> --1 <br /> s � <br /> AN JO,%OL IN GOL N1 <br /> rfi E� f ' 1 `' n t - O <br /> DEPARTMENT .'E LY 04et Application Accepted By Date ) Area7 Employee ID#Final Inspection By Date d ❑ SPECIAL rERMIT-Apprved by <br /> Character of Soil toDe�rof3 F PitlSump Soil Character: <br /> COMMENTS <br /> "' <br /> ev <br /> PE SC Received C ecNil Amount Permit/ <br /> Code INFO $ ash Remitted Date Invoice# Permit 1130 <br /> Scrvicc Rc ucst# <br /> Q' Xd D 357 34, <br /> 42-0I-001 <br /> 1212/02 ONSITE~WASTEWATER PERMIT <br />