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I <br /> ONSITE WASTFMATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPa�.�:NT 301E WEBER AVE-3-PL-STOCKTON�� 202 -ON)CGB-3A20 <br /> NON-REFUNDABLE PERMIT I CALL 209 953-7697 FOR I�SP1ECTIONS EXPIRES I YEA�'FROm DATE ISSUED <br /> FOOADDaPss i " I- -_1 CHT&IP - �• . r_ m <br /> HeSTREET' • APN - +PARCEL SIZE NAME PHONENERARRESSHCITYISTATEIZIPNTRACFOR PHONE ` <br /> CONTRACFORAD.. CYFVISTATUZIP <br /> LICENS[ ❑C-02 ❑C-36 OTHER NUMBER EKPIMTION DATE <br /> WATERTABLE DEPTH: ft GEOGRAPRICALINFO0.MATION: COmJlnnteS XI Y <br /> (] PERCTEST M BUILDINGPERMIT$ LAND USE APPLICATION N TA - - -�' <br /> TYPEOPWORK: ❑ NEWINSCACDCHON ❑ U,PA,H/AHRrUoN ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ DEGREE <br /> NUMBE0.0FLTLNGUNCU: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK IYPFIMFG CAPACITY PI #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPFIMFG CAPACITY gel #OFCOMPARTMENTS <br /> ❑ PKG TK PLANT DISTANCETONEAREST: WELL R FOUNDATION It PROPERTY LIFE ft <br /> r ❑ LIPT STATION SIZE TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) R. <br /> ❑ LEACH LINES ❑ LEACHING CHAMBER$ NOFLMES LENGTH OF LINES R ', <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LME ft ^ <br /> s ❑ FILTER BED WIDTH - ft LENGTH ft DEPTH R ail <br /> DISTANCE TO NEAREEC WELL R FOUNDATION ft PROPERTY LINE ft 1 <br /> ❑ MOUNDED W.. ft LENGTH ft DEPTH R \I <br /> DIETANCETONEAREST WELL Fl FOUNDATION R PRGPERTV LINE It m <br /> _ ❑ $UMTS W. ft LENGTH ft DEPT. ft Qt; <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LME R N� i <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH It - DEPTH R S <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER Wmix R DEPTH R <br /> DISTANCETONEARFST WELL R FOURDAT1ON R PROPERTY LME It <br /> N 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 /> T MIN IM UNI�A HOUR ADVANCE rvOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.707 <br /> 1� SIGNED TITLE 1 1. • (`1 i DATE ✓- 1 C - 5 <br /> I <br /> wsY BIiY ,, li J R I <br /> y <br /> I _ I <br /> it <br /> a �r •r <br /> i' <br /> � I <br /> - <br /> DEPARTM E NT GSE ON L r' <br /> Application Accepted By. Y r '� —'\-� �—' Dnle Q �O> AIre 6 Employ.]Dot74 i7(I q/9/ <br /> Final I.Ipecli..By Dete ❑ SPECIAL PERMIT-Approved by <br /> Chander of Sail to Depth of 3 PC PiUSUMP Soil Chanter: <br /> COMMENTS <br /> PE SC Received /l�COIDW Amaant Dem PermlN Invoice If Donnie IM <br /> r Code INFO B CneM1 Remitted ServlceR ueetp 1 <br /> 37 V`f0 3, p <br /> <2-02-COI O•l. I-, �{ D ONSITE WASTEWATER PERMIT i <br />