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-ITE-WAS ,_^WATER TREATMENT SYS M PERMIT SAN JOAQUIN COUNT, NVIRONMENTAL H#,&R'DE_PARTMENT600 E MAIN STREET-STOCKTON CA 95202.(209)468-3420 NON-REFUNDABLE PERMITGALL(2\9a 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED I J08 ADDRESS -✓ J CITYIZIP �r CROSS STREET G�oirrl> �/ ! APN PARCEL SIZE n 0 19 M M OWNER NAME_ �/,fi f�1 L /c•I / PHONE � y Vi OWNER ADDRESS ' CITYISTATEIZIP CONTRACTOR �7i� �-ctr � �UI�OlX.(. s -___-- PHONE CONTRACTOR ADDRESS � `I /]i/I !✓L - CITYISTATE)ZIP ` I I LICENSE/, C•42 ❑C-36 OTHER NUMBER r�/ :2 EXPIRATION DATE _ k WATER TABLE DEPTH: �' ft GEOGRAPHICAL INFORMATION, Coordinates X �Y ❑ PERC TEST # It BUILDING PERMIT# LAND USE APPLIOATtON# TYPE OF WORK: ❑j NEW INSTALLATION _ REPAIRIADDITION ❑ ENGINEER D SIGNED/ALTERNATIVE F ❑i REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: -,Z—AESIDENCE ❑ COMMERCIAL ❑ OTHER 6 NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: u' ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP IT YPEIMFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) li ft � )d LEACH LINES ❑ LEACHING CHAMBERS #of LINES LENGTH OF LINES I I r.. DISTANCE TO NEAREST WELL 4 �- ft FOUNDATION ! {/ ft PROPERTY LINE f_I ft ❑ FILTER BED Ir kWIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 0 MOUNDED 1'16WIDTHi ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft o SUMPS 1PIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS�a WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS !NUMBERWIDTHft DEPTH _ C—1 7y ft DISTANCE TO NEAREST WELL _ �lj/�`� ft FOUNDATION f O ft PROPERTY LINE_1 ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, i STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED li TITLEr� DATE og - it + i i a I I d i. I s i 6 JS I � f i r AA p I I SN O UN ON QJE TMENT US 0 I Application AcItopth RR Date Area Employee ID## Final Inspectio Date ❑ SPECIAL PERMIT-Approved by Character of Sof 3 Ft: Pi Sump Sail Character: COMMENTS w PE SC Received Check Amount Permit/ Code INFO i B Date as Remitted Service Request# Invoice# Permit ED# O I{ ' I 42-01 A ONSITE WASTEWATER TRTMNT SYSTEM PERMIT I,