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FR TME1868 SYSTEM PERMIT <br /> ONSITE WASTEWAT1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> NON-REFUNDABLE PERMIT CALL 09 953-7 F R INSPECTIONS AE%PIKES 1 YEAR FROM DATE ISSUED V <br /> 1 <br /> Joe ADDRESS ..�-�?5 D • . --------- ------� ,+ _ --_" g <br /> ,ter p i Q ,1 K U —- PAacEL SIZE_.PZ- �- <br /> ! wdt��rcaA - APIC --- <br /> I CROSS STREET ____- <br /> PHONE <br /> OWNER NAtaE_.. S/.y' <br /> Y• �.• LJ �d ZS ___. - CITY/STATE/ZIP <br /> OWNER ADDRESS <br /> PHONE__�'G <br /> CONTRACTOR 11 if <br /> � <br /> CITY/STATE/ZIP --L-- <br /> CONTRACTOR ADDRESS <br /> LICENSE .1 'C-42 �'"C-36 OTHER yp► <br /> i' /1 - NUMBER Ver y �.E%PIRATION DATE_____.------- "— <br /> i ' " <br /> WATER TABLE DEPTH: -,5_ .----it GEOGRAPHICAL INFORMATION: Coordinates X--.__.---- <br /> Y -- <br /> But DING PERMIT# LAND USE APPLICATION#-.-__--- <br /> PERC TEST It ---:71 _----- tNGINEen utawnE /ALTERNATIVE <br /> INSTALREr,AiR/ADDITION <br /> TYPE OF WORK: NEW REPLACEMENT <br /> REPLACEMENT OV7-OE-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> RESIDENCE 1 COMMERCIAL i OTHE�OEMPLDYE.S�a—�� <br /> NSTALLATION WILL SERVE: - - - _ _ NUMSE <br /> NUMBER OF LIVING UNITS' NUMBER OF BEDROOMS:__-,. - <br /> U JL L- CAPACI I DLA__ _ gat #OF COMPARTMENTS Z <br /> ` <br /> 2r SEPTIC TANK TYPE/MFG _ ------- <br /> CAPACITY _.-.-__.--....._ __.._. gal #OF COMPARTMENTS___ ___-- <br /> ❑ GREASE TRAP TYPE/MFG ---- --- - <br /> ft <br /> DISTANCE TO NEAREST: WELL -.-. It FOUNDATION___-_--- it PROPERTY LINE <br /> ❑ LIFT STATION SIZE ____.-TYPE OF PUMP___ _ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> �i #OF LINES LENGTH OF LINES <br /> hp LEACH LINES LEACHING CHAMBERS -- -- ---- <br /> DISTANCE TO NEAREST WELL_LC ---t-. _ ft FOUNDATION .ZO°r l DEPTH it it PROPERTY LINE it <br /> f <br /> ❑ FILTER BED WIDTH______--It n <br /> DISTANCE TO NEAREST WELL _ _ It FOUNDATION it PROPERTY LINE - <br /> ❑ MOUNDED WIDTH .------- __— <br /> ft LENGTH-___ it DEPTH_— _ -------it <br /> DISTANCE TO NEAREST WELL-____.____.. It FOUNDATION __-ft PROPERTY LINE it <br /> -__. ._--it LENGTH-..-------f1. DEPTH -_ --n <br /> ❑ SUMPS WIDTH__.-- _____it PROPERTY LINE_.__---___--n <br /> DISTANCE TO NEAREST WELL_.__-_ f1 FOUNDATION <br /> Il ___ fI _ <br /> ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH it-_.___--.- - n <br /> DISTANCE TO NEAREST WELL _-__ 11 FOUNDATION _t[ PROPERTY LINE__ __-____.-_ <br /> Now, it r0 __-_-____it DEPTH -).� _ it <br /> k7 SEEPAGE PITS NUMBER__.__ WIDTH---�- <br /> DISTANCE TO NEARESTWELL /) __ it FOUNDATION_yZ�° it PROPERTY LINE- C f it <br /> I-HEREBY CERTIFY THAT i HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MIN UM 24.WU DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 / �) <br /> :•- DATE <br /> SIGNED_ ___- TITLE C/'^" r __-- <br /> NA <br /> _ t y� <br /> e,) <br /> a INC <br /> 0CPARTF,,'IE S 0NL' <br /> Application Accept <br /> Date Area&IAPERIIT <br /> Employee ID#fQ�� . <br /> -- -��"� _ <br /> Final Inspection By- - - - - _ Date_� �' --� S -Approved by — <br /> Character of Soil t of 3 FL- __ Pi Sump Soil Charade <br /> CO,MMENTS <br /> re <br /> PE SC Received Check#/ Amount Dale Permit/ Invoice# Permit ID* <br /> Code INFO B Cash Remitted Service R est A <br /> _ _11 I sem... - — <br /> * 647 — <br /> L 4v_)- <br /> 42.0 - ONSITE WASTEWATER TRTMi -EM PERMIT y <br /> �.l`�, Y1i.•.:..)/ �✓fir'%J�G��''c'l� 1a� <br />