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ONSITE WA' TEWATER TREATMENT SYS -EM PERMIT -/O'er <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH`.vARTMENT 600 EARN STREET-STOCKTON CA 95202-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED I <br /> 101rof <br /> JOB ADDRESS O 1 CITYIZIP - m <br /> CROSS STREET 14Z 4 APN n 8~1 - oSy -16 PAROg lz <br /> OWNERNAME Qhj/L. Ah ria1 ✓Ilio PHONE <br /> OWNER ADDRESS �O /yl,,, CITYISTATEIZIP <br /> CONTRACTOR At« I D. /Alvan L PHONE 3A //A <br /> - -3-70I <br /> CONTRACTOR ADDRESS q O;Z II S J/I I/1/ kA.'J CITYISTATEIZIP <br /> LICENSE ❑C-42 �]C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y Q <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# ENO 1 i`IG-- <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION CI ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft 1 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH It `C <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft \ <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 4r <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSALPONDS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft. PROPERTY LINE It <br /> I HEREBY CERTIFY THAT 1 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 /> MINI MU 24 HOU TICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE 6��rJC.• DATE zO <br /> 171 <br /> P <br /> R <br /> 0 <br /> AL <br /> T D P R <br />