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ONSITE WA EWATER TREATMENT SY 1VI PEANUT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTI—JEPARTMENT 304 E WEBE6 VE -3"FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)95377697 FOR INSPECTIONS EXPIRES I NEjA{R <br /> FROM DATE-ISSUED <br /> JOB ADDRESS' L`T AeA 6- ''CITY/ZIP RAC <br /> 9.7 �`r' `' " L1 <br /> CROSS STREET v �", A p APN 2-Z&7—M/0 "/"L! PARCEL SIZE A a /!ty o <br /> OWNER NAME PHONE� 7 _ <br /> /j <br /> OWNERADDRESS atT 0� / _ CITYISTATEIZiP /�� j�J � <br /> CONTRACTORU L-rI N _ .. .. PHONE (p4 b /"'7 a 3 <br /> CONTRACTOR ADDRESS I0, 130 CITY/STATEIZIP L <br /> LICENSE ❑C-42 ❑C-136 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: �' ! 3�S ft GEOGRAPHICAL INFORMATION 2 Coordinates X Y <br /> k <br /> FERC TEST # .BUILDING PERMIT# . : ' LAND USE APPLICATION A <br /> TYPE OF WORK: ❑ NEWINSTALLATION ❑ REPAIR/ADDITION ❑ -ENGINEER DE IGNEDIALIERNATI•VE <br /> !❑ :'REPLACEMENT ❑,.. DESTRUCTION ='• '' <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑f'COMMeRCIAi ❑`OTHER <br /> NUMBER OPLIVING UNITS: NUMBER OF$EDROOMS: NUMHEROFEMPGOYEES:` <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP CI <br /> TYPEIMFG CAPATY gal #OF COMPARTMENTS <br /> ❑r" PKC TX PLANT DISTANCE TO NEAREST; ,:WELL ft, FOUNDATION ' ft,> ''?'PROPERTY-LINE r"I • tt O <br /> ❑ LIFT STATION •SIZE TYPE'OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) s <br /> 's:• :,fir •",: :4 <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #of LINES •CEN&H OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft . <br /> 3 <br /> '❑ FILTER BED WIDTH ft LEN GTH ft DEPTH ft <br /> • <br /> DISTANCE TO NEAREST WELL ft :FOUNDATION ft PROPERTY LINE; wm ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH _.- ft LENGTH DEPTH i $ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft Q <br /> ❑ DISPOSAL PONDS WIDTH ft,. .LENGTH' 7 *j-, fir::lift.:., DEPTH ft F) <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft. <br /> ❑ SEEPAGE PITS NUMBER ft DEPTH. ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> HEREBY C 1FY THAT l' VE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> O INANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY.Fit <br /> OUR ADVANCE NOTICE REQUIRED FORJNSPECTIONS,-PLEAS E.CALL,(20)x95347697 <br /> SIGNED TITLE QWNE2 DATE ' <br /> ��. <br /> 4. \ z <br /> INr N 'f ,pKi c r,1 i}-. F't.i 3+., `�' G i .5i.s <br /> r i- -:r:t - '� a<J <br /> l <br /> rx At <br /> r <br /> I'+ <br /> 7' p N q <br /> K :. <br /> y. <br /> - - fi. ir, 0 <br /> PARTMENT SE ON <br /> Application Accepted By AreaEmployee 1D# , <br /> Final Inspection By Date d © SPECIAL PERMIT-Approved by, <br /> Character of Soil to De of 3 Ft: Pit/Sump Soil Character: <br /> COME TS S�d 1 r <br /> PE SC cei Amount Date Permit/ <br /> Invoice# Permit 1D# <br /> Code INFOY. <br /> Remitted R.,,, Service Re nest# <br /> ' - <br /> �aa 5Z - . <br /> 42-02-001 ONSITE WASTEWATER PERMIT ` <br /> 1212212003 ` <br /> 2 <br />