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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY LNWRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET-STOCKTON CA. (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(201!(953-7697 FOR INSPECTIONS EXPIRES 1 YEAR Fes/ <br /> FCROSSSTREET <br /> DDRES8��S{d3 LO[!TN do pA/ Qp�J MUM DATE ISSUED <br /> 5 CiTY21P rxa e_I ?;� 0 <br /> TseSrATF � APNa5j-1lp-I 4abg7 <br /> �rPARCEL SIZER NAME�2{J AI TA IFy KI` PHONER ADDRESSZIO,I N• TQ ACI6LVDSLyCITY/STATE/ZIp 7naL.� /rpO/s�yi d <br /> RACTOR CNESNNF� C'.rlwlfI,[ �� PHONE (o6Art���l�03 <br /> CONTRACTOR ADDRESS O• S01C 37N4 CITYiSTATEZP IU9L0(� e.4 45301 N <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EKPIRATION DATE AA <br /> W TABLE DEPTH; til R GEOGRAPN GAL INFORMATION: COOrdlnaUN, XV I <br /> PERC TEST # I Y <br /> BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPMRIADOITBR. ^ <br /> ❑ REPLACEMENT ❑ ENGINEER OE SIGNED/ALTERNATIVE <br /> ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RE&OENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMIReROFBEOR00M3: <br /> NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY <br /> GREASETRAP TYPEIMFG gal #OF COMPARTMENTS <br /> CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE <br /> ❑ LIFT STATION SIZE R <br /> TYPE OF PUMP O PKG TX PLANT Cl SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES ❑ LEACHING CHAMBERS #OFLINES <br /> LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE <br /> ❑ FILTER BED WIOTN R <br /> It LENGTH K DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE <br /> 13 MOUNDED WIDTH R LENGTH ft <br /> R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTYLINE <br /> LI sumps WIDTH R LENGTH R <br /> ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNMTION R PROPERTYLINE <br /> ❑ DISPOSAL PONDS WMTN ft LENGTHR <br /> R DEPTH ft <br /> DISTANCE TO NEAREST WELL <br /> L) SEEPAGE PITS R FOUNDATION <br /> NUMBER ft PROPERTY LINE ft <br /> WIDTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION IT, PROPERTY LINE <br /> ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN C <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. OUNTY ORDINANCES, <br /> MINI HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE 0-w-,nz DATE G-/L-OR <br /> R <br /> J <br /> o N <br /> T <br /> PARTME T SE NLY <br /> Application AceeP Date Area Employee ID# � y <br /> Final lnspectian Data �7/��p El SPECIAL PERMIT-Approved by <br /> Character oT it to h gL3 t PItISUmp Sall Chamder. <br /> COMMENTS 6 i <br /> PE SC Received heeM# Amount Date PermW <br /> Cods INFO B u Remitted Service Uest# Invoice# Permit ID# <br /> O <br /> 4241 <br /> 1014M7 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />