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ONSITE' ,STEWATER TREATMENT SYSTEM 'ERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL#�uCTH DEPARTMENT 304 E WEBER AVE-.N_.-STOCKTON CA 95202 - (209)469-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS 1,0F,XPIRF,S 1 VEAR FROM DATE ISSUED <br /> FADDR— 1165-1 �1gT PA L/r1_GL4NE_ _ CITY/zIP Q/PO�t/ 95 337 <br /> /� J� y <br /> uSTl1 AOAJ ____ APN � �OPARCELSIZE/��ie/ C7' C—a/rn-7,9'p, <br /> -/TI E _ PHONE <br /> OWNER ADDRESS 0 • �� /-ILJ CITY/.t FATE/ZIP <br /> CONTRACTOR �/� dA/ kL T PHONE <br /> COMIRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: 4. R GF.00:RAPIOCAL INFORMATION: Coordinate% X Y <br /> ❑ PERC TEST N�1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPATR/ADDTTION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT _ ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: 0 RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIViNC UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> U SEPTIC TANK TYPE/MFG CAPACfrY gal #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> U PKC TX PLANT DISTANCETO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE R <br /> O LIFT STATION SIZE TYPE OF PVMP ❑ SAND 011.SEPARATOR(ENCLOSED SYSTEM) r <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS NOF LINES LENGTH OF LINFS R <br /> DISTANCE TO NEARESTWELL R FOUNDATION fl PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH_ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE. R <br /> ❑ MOUNDED WIDTH fl LENGIIT R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE R <br /> ❑ SUMPS WIDTH ft LENGTH fl DEPTH R <br /> DISTANCE TO NEAREST WELL it FOUNDATION_ R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS W IoTK ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIO'I'K ft DEPTH fl <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> 1 HEREBY CER }'THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTV <br /> DINANCES,STATE LAWS AND RULES AND REGULATIONS OFSAN JOAQUIN COUNTY. <br /> MINI HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 ^� q <br /> SIGNED TITLE .2L(IN`f:R DATE 7 IROS <br /> '-AN,JQ INC U <br /> t <br /> _ DF.PARTMEN7 SE -'NL" <br /> Application Accepted By �(- Dale J' S �S _ Arca _ Employee,IUM _ <br /> Final Inspection By - Date 3 ❑ SPECIAI.PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: et/Smnp Soil Character: <br /> COMMENTS <br /> PE SC Received Check#! Amount Date Permit/ Invoice Permit ID# <br /> Code INFO B emitted <br /> Z2-Z <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12122/2003 <br />