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6. <br /> 60ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 30IE WERER AVE-3"Fl,-STOCKTON CA 95202 -(209)46R-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-76`97 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRFSs I `-s�- -.. l v +° { d -� Cm21P _ IC 1 I f j IV r `A <br /> CROSS STREET APNZ72I�I\ =- 1� PIA RCELSIII�IpC <br /> OWNER NAME \I.i \ G l`Sn�,V t �"^ VH"-J�' PHONE `✓�nF AI 1 <br /> OWNERADDRENE q� Cm/STATE21P <br /> LCONTRACTOR I`J J K PHONE <br /> CONIAACTOR ADDRESS - - 1 CITY/STATVZIP <br /> LICENSE 0 C4 CI C-36 OTHER NUMBER EXPIRATION DATE <br /> 6. WATER TABLE DEPTH: It GEOLMPHICALINFORMATION: CoorElnaM X Y <br /> ® PERC TEST p BUIL DING PERMIT# LAND USE APPLICATION$ `' `T-'/ `+ <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADORION O ENGINEER DESIGNED/ALTEONATNE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATIONWILL SERVE: 13 RESIDENCE 11 COMMERCIAL OTHER <br /> COMMERCIAL H <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBEROFEMPLOYEF3: <br /> ❑ SEPTIC TANK TYPVMFc CAPACITY Ral OOTCOMPARTMENTS <br /> ❑ GREASE TRAP TYPVMFG CAPACITY Ppl #OFCOMPARTMENTS <br /> ❑ PRO TX PLANT DISTANCETO NEAREST: WELL fl FOUNDATION A PROPERTY LINE fl <br /> ❑ LIFTSTATION SIZE TYPEOF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES ❑ LEACHING CHAMBERS pOFLNFs LENGTHoFLMES R <br /> DISTANCETONEAREST WELL R FOUNDATION ft PROPERTY LME R <br /> ❑ FILTER BED WIDTTI R LENGTH R DEPTH fl <br /> DISIANCETONEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ MOUNDED WIDTx fl LENGTH fl DEPTH fl <br /> DISTANCETONEARESr WELL ft FOUNDATION B PROPERTY LINE fl <br /> ❑ SUMPS WIDTH R LENGTH fl DEPTH R <br /> DISTANCETONEARM WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WHIT. R LENGTH ft DEPTH A <br /> L INWANUE"NEcRiErr WELL fl FOUNDATION fl PROPERTY LME R <br /> ❑ SEEPAGE PITS NUMB.. WaYrx ft DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> 1 HEREBY CERTIFY THAT 1 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 /> ` MIN16tUM 14 HOUR ADVANCE NOTICE REQUIRED FOR INSPECT'IONS-PLEASE CALL 12091953-7697 <br /> RIGNED'I - --�_s t TITLE e _ _ Ie��— DATE 1,125 1. <br /> I <br /> 5 I <br /> C <br /> L ° <br /> / <� <br /> DEPARTMENT USE O V <br /> Applleatloo Aecephol By I6c r Date 1✓ .%S L Am Employ«IDM L U`L <br /> Final lnrp«tlon By Date ❑ SPECIAL PERMIT-AppNWW by <br /> ` Character of SeR to Depth of3 Fn PIBSump Soil CM-ch r: <br /> COMMENTS <br /> `a PE SC R«e1Ve0Che,, Amount Date Permitl kp <br /> InroePermItlDB <br /> Cotle Inw B AIR RemineH ServlceR ueMB <br /> Vk Y J Z L <br /> ` 42-02-W I ONSITE WASTEWATER PERMIT <br /> IY Offil <br />