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ONSITE WASTEWATERe""REATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 EMAINSTREET-STOCKTON CA 95202-(209) A 0 NON-REFUNDABLE PERMIT CALL 209 953-76)97 FOR INSPECTIONS EXPIRES'I YEAR FROM DATE ISSUED JOB ADDRESS ! f, i 1 I:! ''I✓ / (\,. CITWLIP ! 1 _ r CROSS STREET L t l APN PMCEL$¢E OWNER NAME PHONE 1 OWNERADBRES3 r .J. , CITYISTATE21P {�� 4 COMTMCTOR !� /bs 5.1, PHONE CONIIUCTORADORES$ �:' 1 'C-1' L.I •/sCRYISTATFJZIPc, LICENSE QC4 QC-36 OTHER NUMBER E IRATON DATE WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: COOrdlnal&9 X Y ❑ PERCTEST # Q BUILDING PERMIT# LAND USE APPLICATION III -i - 90: TYPE OF WORK: ❑ NEW INSTALLATION ❑ RVMR/ApDl ❑ ENGWEER DESIoxeu/ALTETwAnvE D REPLACEMENT ❑ DESTRUCTNIN INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER �"• NUMBER OF WHO UNMS: NUMBEROPBEOROOM3: NUMBER OF EMPLOYEES: O SEPTIC TANK TYPEIMFG CAPACITY gal #DF COMPARTMENTS D GREASETRAP TYPEJMFG CAPA gal #OFCOMPARTMENTS DISTANCE TO NEARl6Y. WELL 6 FOUNDRTON K PKOPERTY LINE R O LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT Cl SAND OIL SEPARATOR(ENCLOSED SYST9A) 1 O LEACH LINES ❑ LEACHINGCHAMBERS #OF LINES LENGTHOFUNES ft DISTANCE TO NEAREST WE, ft FWNDAnON ft PROPERTY THE O FILTER BED WIDTH It LENGTH ft DEPTH It �1 DISTANCE To NEANEST WELL ft FOUNDATION R PROPERTYUNE ft O MOUNDED WIDTH ft LENGTH ft DEPTH It D13TANCETONEAREsT WELL ft FOUNDATION It PROPERTI'uNE ft_...._ O SUMPS WIDTH It LENGTH It DEPTH It DISTANCE TO NEAREST WHL ft FOUNMTtOi It PROPERTY LINE It —O DISPOSAL PONDS WIDTH ry LENGTH It DEPTH ft DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY JNE ft O SEEPAGE PITS NUMBER WIDTH It DEPTH f[ , DISTANCETONEAREST WELL ft FOUNDATION It PROPERTY LINE ft —I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM Mp 0�/Y L'.ADVVANCE•N9TICE REQUIRED FOR INSPECTIONS-IPLE,ASE CALL(209)953-7697 SIGNED 1 �. L.- .�/I TITLE --!C 1:t I C" DATE !_ '^/ 07 i J P O /R I /J DEPARTMENT USE O LY nH,E ;T.t•. . Application Acceplad SYS y%��YY�I. t,�,•. Dale -.'%.- ��d 4 Area Employee l0# ' —Flnallnspectian By Gate / ❑ SPECIAL PERMIT-Approved by Character of Solt to Depth of 3 Ft: PINSump Soil Character. COMMENTS PE SC Received Check#! Amount ParmW Cada INFO B L-Cash Remltted ale Servlca oast# Invoice# PeYmft 1D# - is 3 3 ' 62-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 101""