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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HELLTN DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)O6B- O <br /> eMNON-REFUNDABLE PERMIT CALL 209 953.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDaESs 1"1 1 S x -1 1— f Y L C; COTrza+ `+"j'. r.-� ,;..1 /` J2(, 22 <br /> CROSS STREET L, APN PARCEL Sul' <br /> OWXEII HANE V ;...� i^I I/\�I T/ PHONE B <br /> OWNER ADDRESS /' Cm/STATP21P P <br /> CONRUCTOR H / :// F6 41"r PHONE <br /> CO crrOR ADDRESS III/ I/ jj �/ CITYISTATELDP j. C//�,IP \• <br /> FT <br /> LICFHSE QCd QCJB OMEa NUMBER EUnBAnON DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATRIN: COOldl1 X Y <br /> ❑ PERCTEST % BUILDINGPERMIT# LAND USE APPLICATION# `^I <br /> TYPE OF WORK: ❑ NEW ImemJL"TON ❑ REPAWADDRUm ❑ ENGINEER DESIGNED/ALTERNATWE <br /> C REPLACEMENT C DESTRUCTION <br /> INSTALLATION WILL SERVE: C RESIDENCE ❑ COMMER ❑ OTHER ^(, <br /> NUMBEROFLNNGUNOS: NUMBEROFBPDRDOMS: NUMBER OF EMPLOYEES: <br /> O SEPTICTANK TYP FG CMACITY gal #CFCOMPARIMENTS <br /> O GREASE TRAP T IMMFG CMACITY gal #OFCOMPA UENT5 <br /> DMTWICEMNEARI WELL ft FGUNDATON ft PROPERTYLINE ft ? <br /> O LIFTSTATION SIZE TYPE OF PUMP Cl PKG TX PLANT D SAND OIL SEPARATOR(ENCLOSED SYSTEM) - <br /> O LEACH LINES ❑ LEACHING CHAMBERS #oFLINES LENGTHOFLINES ft <br /> DISTANCETONEMEST WELL ft FOUNDATNM' ft PROPERT UNE ft <br /> O FILTERBED WaTrN ft LENGTH It DEFTH ft <br /> DMTAHCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O MOUNDED WImN ft LENGTH ft DcP ft <br /> DISTANCE TO NEAAM T WELL ft FOUNDAnON It PROPERTYLINE ft <br /> O SUMPS Ww it LENGTH ft DEPTH It - <br /> DwmcETONEAIEST WELL ft FOUNWTION it FRCPERNUNE ft <br /> O DISPOSAL PONDS WRRN ft LENGTH ft DEP It <br /> Derma TO NEAREST WF1L ft FOUNDATION It PROPERTY LINE ft <br /> O SEEPAGE PITS NUMBER Mr. ft DEPTH ft <br /> Darr.ca m NEAaEST WELL ft FOUNCAMON ft PROPERTY UNE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE GONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS ANO RULES AND REGULATIONS OF SAN JOAQUIN COUNtt. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7897 <br /> SIGNED -,` __.__ _ c...:_ TITLE <br /> ( <br /> - iIFIC C <br /> R 71 <br /> �/ / DEPARTMENT OSE Y rr <br /> Applirallon Accepted By'�.ILi 6/� L'L. i Dab V�. ' U 7 Area EmpIOYBE ID# `fes✓�S <br /> Fine)WSPICHM BY Data / ❑ SPECIAL PERMIT-ApproveG by <br /> - <br /> Character of Soli to Depth of 0 Pt: PRIGUmp Soil Characbr: <br /> COMMENTS <br /> CPEFarrow <br /> OM IHFO R B V� RemNao DetB S.,caR Uaat#_ Imola# Pertnil l0# <br /> 4201 ONSffE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 1aaDT <br /> r ` <br />