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ONSITE WASTEWATER TREATM.{_ T SYSTEM PERMIT!' ... <br /> - SAA'JOAQUIN COUN'T]'ENVIRONMENTAL HEALTH DEPARTMENT 304 E%VEBER A VF-3-171--STOCKTON CA 95202 - <br /> f NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPLCTIONti R <br /> EX TIRES l YEAR FROM DAATETE fI!8-3420 <br /> 55 F,D <br /> JOB ADDRESS ^.. .J _R.''1 -�'t� �.� CITVIZIP 1 LgG-y t� ,1� <br /> r <br /> CROSS STREET L�;,t,^f1t1 t7� C�"j /+10I_ r <br /> II APN rJ PARCELSIZE <br /> OWNER NAME +.JVI j Iyy I t✓ — 6 <br /> PHONE F <br /> 1�`r' OKI'ER ADDRESS CITYISTATEIZIP <br /> F { CONTRACTOR I ty ,' r:<GC:k: fJrCG PHONE <br /> ttt���rrr CONTRACTOR ADDRESS '� CETVISTATE/ZIP e.v L'], r - <br /> 1 LICENSE ❑C-4? LIC-36 OTHER NUMBER ' EXPIRATION DATE <br /> f WATER TABLE DEPTH: fl GEOGRAPHICALINFORMATION: Coordinates X Y <br /> PER!! ❑ TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF OF WORK: NElS'fNSTgLLATION Q REPATR/ADDITION Q ENGINEER DESIGNED/ALTERNATIVE <br /> LI REPLACEMENT J DESTRUCTION <br /> INSTALLATIONWILL SERVE: R <br /> BESIDENCE Ll COMMERCIAL <br /> �J L3OTHER <br /> pp <br /> NUMBER OF LIVI NC UNITS: I NUMBER OF BEDROOMS:_ `I NUMBER OF EMPLOYEES: <br />! 1if SEPTIC TANK TYPElh1FG ( ��� CAPACITY gal HOF COM1IPARTM11EN75 <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCETO NEAREST: WELLft O FOUNDATION ! � <br /> S _� <br /> ❑�i.tFT STATION ��SIZto fl <br /> TYPE OP PUMP E Q fl PROPERTY LINE SAND OIL SEPARATOR(ENCLOSED SYSTEM)# 2 LEACH LINES Id LEACHING CHAMBERS j6q -a t!OF LINES ` LENGTH OF LINES_ t ft <br /> DISTANCE TO NEAREST WELL-_�"'D ft FOUNDATION tqt ft PROPERTY LINE (fir R <br /> ❑ FILTER BED WIDTH ft LENGTH A DEPTH <br /> ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTY LINE g <br /> ❑ MOUNDED WIDTH ft LENGTH fl DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ SUMPS WIDTH ft LENGTH fl DEPTH fl <br /> DISTANCE TO NEAREST WELL- ft FOUNDATION ft PROPERTY LINE fl <br /> - LJDISPOSAL PONDS WIDTH ft LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE g <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> I DISTANCE TO NEAREST WELL ft FOUNDATION 8 PROPERTY LIVE fi <br /> F 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL RE DONE IN ACCORDANCE WITH SAN JOAQD IN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M//ININIUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INISPECTIONS-PLEASE.CALL(209)953-7597 <br /> SIGNED TITLE C,!�lt;�y41�f-,�(' DATE ��c> <br /> f <br /> Fill <br /> I <br /> F <br /> I <br /> 4 7 f::ii h <br /> S ,1 P .JI, <br /> E <br /> l <br /> FFT <br /> I � I <br /> - EPARTMENT U ON Y Q <br /> F Application Accepted Date Area Employee IDN �L <br /> Final Inspection By �� ''37'1 -Date �� ❑ SPECIAL PERMIT-Approved by <br /> Chars of Sail to Depth of 3 Ft - PHIS Sail Character: <br /> COMMENTS iy <br /> FF 1 PE SC Received Amount Permit/ <br /> Code INFO Cash emitted D to Service Re Ucs(# IRvoire# Permit ID# <br /> 42-02-001 <br /> 1712212003 ONSITE WASTEWATER PERMIT <br />