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A <br /> ONSITE WASTI,.,oATER TREATMENT SYSTE,` ?ERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3""FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL <br /> CALL 209 n9533-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS � - -33 /Vi PACK �/�lE /W� CITY/ZIP W.41n PO q �-�-d y <br /> CROSS STREET rELTEIZ nn& -U APN OD72B0 —�2- PARCELSIZE A�— <br /> OwNlRNAME TLtID Lf➢yCE OLGESF p10NF: 631 - C,-z - 4O42 <br /> OWNERADDRESS J• <br /> p0A�' <br /> o - aox 1673 4 CITY/STATE/ZIP rA R/✓fEL GA 93�/i/ <br /> CONTRACTOR CHESNE C on/I U L-r-lAJ6 PHONE GG B-/410-7 <br /> CONTRACTORADDRESS P. K !3 MA CITY/STATE/ZIP /wRL�O4l CA <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: �®O 7` A GEOGRAPHICAL INFORMATION: Coordinates X Y 1 <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAHUADDITION ❑ 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 TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LME ft <br /> ❑ LIFT STATION SIZE TYPE OF Pump ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTYLINE R <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH RW� A' <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft VV <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ftI1• <br /> ❑ SEEPAGE PITS NUMBER WIDTH V R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY \\I <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 24 HOUR ADVANCE NOTICE.REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 / LL <br /> SIGNED TITLE �WA/E+� DATE `l <br /> <Z.i� <br /> E T <br /> REO I ED <br /> p 005 1112 1 11A �Il <br /> S p OUNTY <br /> NT AL <br /> T D PA TMENT <br /> - DEPARTMENT FSE E QNLY <br /> Application Accepted By Date /2 S Area Employee ID# <br /> i <br /> Final Inspection By _.!� <br /> Dal <br /> 1:1 SPECIAL PERMIT-Approved by <br /> Character of Soil to.Depth d3 Ft/:l Piu Sump Soil Character: <br /> COMMENTS �! Y i ."rJz!�",A - �r'��' r'l�' -�✓' i� �a✓l`�! <br /> PE SC Received Chec ryAmount Perm!V Permit <br /> Code INFO B Cash Remitted Date Service Re uesI# Invo c - <br /> 14 .zz mal ,23$17 4f37z-1� p <br /> - I <br /> 42-02-001 � �. t nTEIItlA]S.IEw 'ER PERMIT <br /> Iz/zzanDJ <br />