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_ ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> I JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3'"FL-STOCKTON CA 95202 -(209)468 <br /> )N-REFUNDABLE PERMIT CALL 2O9 953- nR ITS P$CTIONS EXPIRES 1 YEAR FROM DATE IS <br /> - -- - �..� <br /> JOS ADDRESS � •� 1. f•1 a .-^r .,• � '� C[TYIZ.IP �'�� tr C •1� y <br /> _ y � <br />' <br /> L"t <br /> rRO55STREE! ILP� ��rlLN' CvAPN �' t'` 1 PAR1E.LSIZER NAME i .4j PHONE <br /> , 4 <br /> OWNER ADDRESS - t• �' !t, S CITYISTATEIZIP F -r'• !'a I t - -L <br /> A ; <br /> .00INTRACTOR _1 1• 1 f' - _ PHONE - - <br /> -� NTRACTORADDRESS CITVISTATEIZIP <br /> 11G� <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICALIN'FORMATION: Coordinates X Y <br /> FERC TEST # -7:-- DIfILDING PERMIT# -LAND USE APPLICATION# <br /> PE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNEDIALTERNATIVE� <br />' - Q REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER - <br /> II NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 1 SEPTIC TANK TYPEIMFG CAPACFry gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYP£IMrG CAPACTrY gal #OF COMPART.MCNTS <br /> FI PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LINE R <br /> L <br /> LIFT STATION SIZE TYPE OF PUMP LJ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LIN£S ft <br /> DISTANCETO NEAREST WELL fl FOUNDATION ft PROPERTY LINE R <br /> FILTER BED WIDTH ft LENGTH ft DEPTH fl - - <br /> DISTANCETONEAREST WELL fl FOUNDATION ft PROPERTY LINE fl <br /> L3MOUNDED WIDTH ft LENGTH ft DEPTH O <br /> tt DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LME <br /> SUMPS WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft <br />} DISPOSAL PONDS WIDTH ft LENGTH R DEPTH ft <br /> 7 DISTANCE TO NEAREST WELL R FOUNDATION ft +PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER WmTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft <br /> [HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY _ - <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> -' MIN'IMU•N1 74 HOUR ADVANCE NO'I•ICE REQUIRED POR INSPECTIONS-PLLASE CALL(269)953-769 i <br /> 7 <br /> iNE,D <br /> - -. .-..�.-_�-.�.._�._'�—.�,.. t`�__.__..___... TITLE �r : ;-' r. - DATE <br /> -- — — ---- — - I— <br /> a a r �T 5 {: <br /> T5.94 AG Z <br /> I A§ .I <br /> Z <br /> _- 5 ffI 'ISI s .. <br /> 5e-e <br /> Li <br /> `15 Ia it - - - qVi Rn <br /> L �` - . <br /> Ncre-A.­„ IFJ TI I D P RT E 1T <br /> 4 IB Avress , <br /> j j— DEPARTMENT USE ONLY L <br /> Lpplication Accepted By ,r - ! Date.' S C Area. Employee ID# ! l <br /> Final lnspeetion By Date _. _ ❑ SPECIAL�PERMIT-Approved by <br /> �In meter of Soil to Depth of 3 Ft: lPIQSump Soil Character <br /> DMMENTS. .. <br /> PE SC Received Cheek# •Amount � .Permit! _ 1 <br /> -Date -Invoice# Permit 1D# <br /> Code 1rFD B Cash ,Remitted _ Service Request# <br /> � <br /> -02-0Dt <br /> TER PERMIT <br /> ONSITE WASTEWA <br /> �nsriaD3 - I <br /> �- 1 <br />