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7f�- g6�9 <br /> ONSITE WASTEWAT lTtE,�TMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 09 953-70"F R INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS I-L _ _/I• �W�/ �"L�unt.4 -... _ CITY/ZIP. <br /> CROSS STREET — Iz APN_ O I .�/� 0_ _PARCEL SIZE <br /> OWNER NAME brkQkflK. _N_' LS/I`�'_ _ PHONE_ <br /> OWNER ADDRESS `�- ✓v' `O-I-s- CITY/STATEIIIP <br /> CONTRACTOR__- ,4-1l� �___-���L 1 PHONE___LI �j[� 9 <br /> ___ �I�j� �JZ <br /> f <br /> CONTRACTOR ADDRESS /SVG I'GS,1"I n CS �of _ _.__.._.__—CITY/STATE/ZIP <br /> LICENSE I C-42 i.l1.1C-36 OTHER- _ NUMBER �`�'TEXPIRATION DATE. <br /> WATER TABLE DEPTH: _ _.- _ft GEOGRAPHICAL INFORMATION: Coordinates X _ __ __ Y <br /> PERC TEST I BUILDING PERMIT# j_4_0_'3ffVq LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDTTION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> � INSTALLATION WILL SERVE: RESIDENCE I I COMMERCIAL I OTHER <br /> . ,_�/ p NUMBER OF LIVING UNITS: _ -_ NUMBER OF BEDROOMS:,____,-- // NUMBER OF EMPLOYEES: <br /> 10 SEPTIC TANK TYPE/MFG W—C, r JLL._ CAPACITY 1400 gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG __. _._ CAPACITY gal #OF COMPARTMENTS. <br /> DISTANCE TO NEAREST: WELL It FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE _._. TYPEOFPUMP-__ O PKGTXPLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> R LEACH LINES LEACHING CHAMBERS _ #OF LINES _ LENGTH OF LINES �� ft <br /> DISTANCE TO NEAREST WELL ICO f ft FOUNDATION .10'f -it PROPERTY LINE SOJ ,f it <br /> ❑ FILTER BED WIDTH _It LENGTH __ ft DEPTH It <br /> DISTANCE TO NEAREST WELL_ _ ft FOUNDATION It PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH___ it DEPTH R <br /> DISTANCE To NEAREST WELL _ _ II FOUNDATION It PROPERTY LINE it <br /> ❑ SUMPS WIDTH ft LENGTH _ It DEPTH it <br /> DISTANCE TO NEAREST WELL _ it FOUNDATION _it PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH __ _ft LENGTH _ _ _ ___ ft DEPTH It <br /> DISTANCE TO NEAREST WELL_ _ It FOUNDATION __It PROPERTY LINE it <br /> Ia SEEPAGE PITS NUMBER___�t WIDTH_ 6� It DEPTH -Z..f _It <br /> DISTANCE TO NEAREST WELL IS'O+ It FOUNDATION (00 / it PROPERTY LINE .Sao � It <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 REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24HOqUOVANCE NOTICE_REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED /j�f� TITLE D,.Jn DATE <br /> f <br /> �h <br /> 1 , <br /> _ V4 O - <br /> r <br /> 1 I <br /> J O IN C <br /> DEPARRTAIEN I USE 0,NL <br /> Application Accepte 1- Rate/ Q _ Area Employee ID# � <br /> Final Inspection By __ _._ Date_ ___ f 1 S IA PERMIT-Approved by <br /> Character of Soil It De ,o-f 13 Ft:_ Pi Sump Soil Charade <br /> COMMENTS Is <br /> PE SC Received Check#/ Amount Perm[V <br /> # <br /> Date In Permit ID# <br /> Code INFO �7BCash_ Remitted Service Request# <br /> tTJ I SA <br /> AMe-?cYe��-9 3 O,' 7 <br /> 42-01 / ONSITE WASTEWATER TRTM... _,...EM PFR11R <br /> 4*4.!,2 �v� /�/i /1Gs: l/� A_ <br />