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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOA COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE -3"FL-STOCKTON CA 95003�)468-3420 <br /> NON-REFUNDABLE PERMIT 2 CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR <br /> FROM DATE ISSUED <br /> JOBA TRESS 33 E CITY/ZIP _ c�.YI /s ZZ <br /> CROSS BEREFT APNL _SPARCEL SIZE <br /> OWNERNAME (1� C "e )�S PHONE <br /> OWNER ADDRESS 333 ACITY/STATE/ZIP s(fI "Cr/pp -S <br /> CONTRACTOR q?ZE) <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: 17 eJ t ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: X:7 NEW 170N ❑ REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: (.0 RESIDENCE ❑ COMMERCIAL ❑ OTHER (� <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: '7Id NUMBER OF EMPLOYEES: t <br /> SEPTIC TANK TYPE/MEG �LL.` 2e�t /P� 1 G CAPACITY /G �O �- <br /> gal 40FCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MPG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ L #OF LINES =x__ LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE <br /> 13 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH II <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE II <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH ft <br /> JJ DISTANCE TON AREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> Ill SEEPAGE PITS WIDTH .�ft LENGTH ft DEPTH ;Z / ft <br /> I/ \ DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE ( JI zJ DATE � <br /> 'ISI` <br /> Ml <br /> vmm� r• ,r,m <br /> r mm� a+a <br /> �"au mm-a I PUB!Tc,I fEAI ' <br /> I I <br /> , <br /> I I <br /> I , w,wertw� <br /> mm _----- <br /> ------------------------------------ <br /> I I I <br /> I <br /> I I I <br /> 1 I I <br /> I <br /> i ceari.u� I I <br /> I s.ff <br /> iEz�n 1��' <br /> L------------------------------------- <br /> , <br />