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ONSITE W r* <br /> /ATER TREATMENT S1 I�PERMIT � /� <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEA�EPARTMENT 304 E WEBS -3""FL-STOCKTON CA 95202 - (209)468-3420Q <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSU;6 3J <br /> JOBADDRESS L'f 6-;4e 2/J CITY/ZIP IN kLlT N <br /> CROSS STREET APN C /1 /') ', ARCELSIZE <br /> OWNER NAME e PHONE <br /> OWNER ADDRESS i3lf yn_ 7 KV ��pni <br /> CITY/STATE/ZIP <br /> CONTRACTOR �til rray�t CPHONE 4 N ff- t 75 <br /> CONTRACTOR ADDRESS ADDRESS Zy Z'5 . �j(�Y � CITY/STATE/ZIP ) rlk�ej <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X V <br /> PERC TEST(S) NIIMRIiR LAND USF APPLICATION# <br /> TYPE OF WORK: ❑ NEW INS'I'ALI.A'1'ION ❑ REPAIR/ADDITION ❑ ENGINIIIIR DIISIGNIID/ALT'F.RNA'rivE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER 1 <br /> NUMBER OF LIVING UNITS: \ t e <br /> NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ` <br /> ❑ SEPTICTANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES R <br /> I DISTANCE TO NEAREST WELL R FOUNDATION fl TV NE R <br /> ❑ FILTER BED WIDTH R LENGTH Il <br /> DISTANCE TO NEAREST WELL R FOUNDATION PER'I LINE Ij <br /> ❑ MOUNDED WIDT11 R LENGTH EF R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH fl <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH Ij <br /> DISTANCETO NEAREST WELL R FOUNDATION Il PROPERTY LINE R <br /> El SEEPAGE PITS WIDTH R LENGTH Ij DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PRETARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> ATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> A UI#ADVANCE NOTICE REQUIRED FOR INSyPPECTIONS—PLEASE CALL(209)953-7697 (0 <br /> SIGNED TITL P,NG/N DATE <br /> ww- <br /> iy�fn � I rt <br /> • _ate k <br /> { <br /> - I <br /> (p) <br /> Lv <br /> i6 .- <br /> "'� <br /> 4 DEPARTMENT U' <br /> Application Accepted Y Date 6 Area Employee ID# { <br /> Final Inspection B Date ❑ SPECIAL PERMIT-Approv d by �04�0.3 / <br /> Character or So t pth r3 Ft: Pit/Sump Soil Character: <br /> COMMENTS�9�9��7m 3 /'u�i� cm.r. .rd ar /�sac✓o/ f fi �� 3'ar Fi/ �s'� 6 -� <br /> /�>/a�� �„�_ c�.✓�ir oa, �� i / r .� •�i-a.sr�. .3�'n io:Ler 4.75 •d <br /> PE SC Received Check#/ Amount Permit/ <br /> lode INFO 8 cash Remitted Date Service Re uest# Invoice Permit ID# <br /> ,1 i.•a <br /> •Z �� �l88'� ( < o n3 oa3 s.Slo 1�a� <br /> �\I` •i:.may %7U .Uj :.J �-'.$p .Oj <br /> QNSITE WASTBWA.'FFB+PFJMR,y <br />