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TEWATER TREATMENT SYSTEM PERMIT <br /> ONSITE wAS 600 E MAIN STREET-STOCKTON CA 95202.(209)468-3420 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> C <br /> '/J 0 B ADDRESS 7,�i v L. lit- ITY/Z I m <br /> CROSSSTREET I APN PARCEL SIZE <br /> "- - ) z/7o- 7-6 R, <br /> OWNERNAME PHONE -��02 <br /> OWNER ADDRESS 2-7 CITYISTATE/ZIP <br /> � � !) "1-7 <br /> PHONE <br /> CONTRACTOR <br /> CONTRACTOR ADDRESS k3' CITYISTATEMP Loy? <br /> LICENSE EIC-42 OC-36 OTHER NUMBER EXPIRATION DATE <br /> Y <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: COOrdlnat®5 X <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# PA <br /> TYPE OF WORK- 11 NEW INSTALLATION D REPAIRiADDITION ❑ ENGINEER DESIGNED!ALTERNATIVE <br /> 0 REPLACEMENT 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: D RESIDENCE 0 COMMERCIAL [I OTHER <br /> NUMBER OF LIVING UNITS:.. NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> CAPACITY gal #OFCOMPARTMENTS(3 SEPTIC TANK TYPEIMFG <br /> 13 GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE To NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> IFI C3 LIFT STATION SIZE TYPE OF PUMP 13 PKG TX PLANT El SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 13 LEACH LINES 0 LEACHING CHAMBERS_ #OFLINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION—ft PROPERTY LINE ft <br /> 13 FILTER BED WIDTH —ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL _ft FOUNDATION ft PROPERTY LINE ft <br /> 13 MOUNDED WIDTH —ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> E3 DISPOSAL PONDS WIDTH ft LENGTH -ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> E3 SEEPAGE PITS NUMBER — WIDTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION —ft. PROPERTY LINE ft <br /> 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 /> M!INIMUM`IHOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE DATE <br /> I I A <br /> 6 <br />