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L <br /> LONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUM CONMTY ENVIRONMENTAL HEAT DEPARTMENT 800 E Mux STREET-STOCKTON CA 95202-(209)168 20 <br /> NON-REFUNDABLE PERMIT CALL 2091 953-7697 FOR <br /> 1INSPECTIONS t EXPIRES 1 YEAR FROM DATE ISSUED <br /> L JORADDRESS I T , , T K J CT LP G� CAS , 4 <br /> 1 �7 AP Y751- 19n-'4: t <br /> LROSSSTREET i'"I-�T"�J' PMCELS6E <br /> ONNER N.E l`.�� !T `(...> >�% � -PHONE <br /> OYNERADDRESS I,J KO CT/ISTATII <br /> CONTRACTOR , PHONE <br /> CONTRRCTdtADOREBS_� <br /> LILMIfF Qf:�2 QC OTIR NUMBER EXPIRATION DATE <br /> L <br /> 6. <br /> WATRTNBLED.: ft GEOORAPHICALINHMMATHNI: COOIOIMU$ X Y <br /> PERC TEST S BUILDING PERMIT M LAND USE APPLICATION Y <br /> TYPE OF WORK: ❑ NEW MSTA MUI n RRUMAOgTON ❑ ENGMRRDEMONEOIALTRMATNE <br /> ❑ REPLACEMENT ❑ D.C. <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMp1C4LL ❑ OTHER <br /> IMM, NUMBROFLWWGUINTS: NUMBROFBEDROOMS: NUMBROFEMPLOVRS: <br /> ❑ SEPTICTANK TYPERAFG CAPACITY Dal BOFCCMPARTMENT9 <br /> ❑ GREASE TRAP TYPEWFG CAPACITY DBI R OF COMPARTMENTS <br /> DISTANCETONEAREST: WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ LIFTSTATION SUE TYPE OF PUMP ❑ PKGTXPLANT O SANDOILSEPARATOR(ENCL.OSEDSYSTFM) <br /> O LEACH LINES C LEACHINGCHAMBERS MOPLINES LENGTHOFUNES fl <br /> r <br /> DL4TANLE TO NEAREST WELL R FOUNDATION R PROPEHiY LINE fl AL <br /> r. ❑ FILTER BED W. R LENGTH It DEPTH R 'S <br /> DISTANCE To NEAIRET WELL-ft POU D TION_ft PROPERTYUNE ft <br /> ❑ MOUNDED W. R LENGTH R DEPTH R J <br /> DISTWILE TO NEAREST WELL R FOUNDATION R PROPERTY LME ft <br /> Cl SUMPS WIDTH ft LENGTH It DEPT ft <br /> DISTANCE TO NEAREST WELL R FOUNOATON R PPOPERTY UNE fl <br /> ❑ DISPOSALPONDS W. R UNGM ft DEPT fl G <br /> DISTANCE TO NEARUt WELL R FOUNDAnIXI ft PROPS uNE fl <br /> ❑ SEEPAGE PITS NUMBER WIoM R DEPTH fl <br /> _ DWRNCE TO NEAREST WELL ft 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 ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIXNS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 20 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(L2�09)555.71HU <br /> SIGNED I. _'t-- 1 _. _ o _moi TITLE - I i..._. \ DATE <br /> F'. <br /> _ I N <br /> O <br /> I✓ <br /> L D <br /> i <br /> ` r u TY <br /> L <br /> DEPARTMENT USE ONLY <br /> APWIratIm AaDeptea By =�L 3 12 /r-5 AMM Employee IM 53(b i 4y <br /> Floal IMSpadIOM By Date ❑ SPECIAL PERMIT-APWuNEJ by <br /> _ Character of Soll to GRN of 5 FV PiVSUmP SOH CnandM: <br /> COMMENTS <br /> ` <br /> C. � Rxcivaa ._.=S � = DAtM Serv14�DAWaMf InvdpR PemLn <br /> 42za saN 2i ?<ct 9,os.N ) l*,f(5 <br /> 69 42-01 CNSOE WABTEWATEA TRTMNT SYSTEM PERMIT <br /> TvaroT / <br />