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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SANJOAQUINCOUNT\ ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE 3-FL-STOCKTON CA 95202 - <br /> NON-REFUNDABLE PERMIT CALL(2021953-7697 (AT 46SUED <br /> E� FOR I�NPecTlo�s EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS I / <br /> CITY/ZIP cS 4(_T <br /> CROSS STREET /\f '/ VAPN UJ'�-�J <br /> CITI'/STATE/ZIP 1"':I NjNG'1 JP`AR}C-<E(L SIZE <br /> OWNER NAME 'I <br /> PHONE <br /> �3L9—�53 OWNER ADDRESS <br /> CONTRACTOR t'� J Kl �Gl..) Rnu���-s L PHONEC <br /> CONTRACTOR ADDRESS CITY/ IP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER <br /> EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# i4 - [J Lp <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGIN EER DESIGNED/ALTERNATIVE <br /> O 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 /> ❑ GREASETRAP 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 Cl LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> EIFILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL B FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH ft - <br /> DISTANCE TONEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> L) SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH B DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> L3 SEEPAGE PITS NUMBER WIDTH R DEPTH It <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> I 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 / <br /> SIGNED J %j� TITLE (2-fl '"JOE-R- DATE l 13" CDS <br /> AL s <br /> v <br />