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ii <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 306E WEBER AVE-Pr FL-STOCKTON CA 95202 -(209)469-3620 <br /> NON-REFUNDABLE PERMIT CALL 209 956-7697 FOR INSPECTION'S EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Cm/ZIP <br /> C <br /> _` m <br /> CROR43TRCET /N 123-��A� APN U P! .1641/ PARCELr9Vl�_ e <br /> OWNER NAME /�PJAj.T �FJf�S' X.�/•IL, PHONE 34-7 =!78. <br /> — /0y <br /> OWNERADORILM III Sgha� Cm/BFATEM" <br /> CONTRACTOR PHONE <br /> CONTRACI'ORADDIUM CMYMATVZIP <br /> LICENSE Ch C42 0C-36 OTHER NUMBER EEPIMTON DAT[ <br /> WATER TABLE DEPTH: R CEOGRAPHICALWFORMATION: Coordinates X Y <br /> PERCTEST M BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION 0 REPAIRMMITION ❑ ENGIMERDMI:NEDJALT[RNATIVE <br /> ❑ RERACCMEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: LI RESIDENCE ❑ COMMERCIAL ElOTHER <br /> NUMB[ROP LI..NCUNm: NUMBER OF BEDROOMS: NUMBEROPEMPLOYEES: <br /> ❑ SEPTICTANK TYPEJMM CAPAC" SAI NOTCOMPARTMENTS <br /> O GREASE TRAP TYPF/MTO CAPACITY_ Sal NOFCOMPARTMENTS V' <br /> ❑ PKG TX PLANT DIWA.MMNEAREST: WELL R FOUNDATION ft PROPERTY LINE fl <br /> ❑ LIFT STATION SIzE TVPEOFPUMP O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES O LEACHING CHAMBERS NOPLM9S LENGTH OT LINES It m <br /> DIWANCETONEAREST WELL It MUNDATION ft PROPERTY LINE R <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCETONEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> (3 MOUNDED WDDI It LENGTH ft DEPTH fl -� <br /> DISTANCETO NEARP.ST <br /> WELL R FOUNDATK)N A PROPERTY LME fl <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH R <br /> DISTANCETONGRM WELL R FOUNDATION R PROPERTY LINE fl <br /> O DISPOSAL PONDS WIDTH R LENOTH ft DEPTH fl <br /> DISTANCETONEAREST WELL R FOUNDATION ft PROPERTY LIM fl <br /> ❑ SEEPAGE PITS NOMRL[ WI. ft DEPTH R <br /> DISTANCETONEAREST WELL, ft FOUNDATION fl PROPERTY LME fl <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 r <br /> SIGNED - E iL--- DATE b• NL• C IU <br /> lu hu 9-1 L, <br /> N IAE <br /> H H <br /> -EPARTME T 4E V <br /> ApplkalbD Aaept Date EE rT Arte EmpI9Ya 1 _ <br /> FIRM lnpaODn8 Deb �ir[/�yC ❑ SPECIAL PERMIT-Approved by <br /> ChRra9brof Sollb Deghof3 C / PIUSump Sell Channbr: <br /> COMMENTS �� �-> JC'-E �,€•- �/i .F �� �c �sJ <br /> PE 9C R..iY ChabN Amount Dab PermiU hrPolm N PermH IDN <br /> Cede INPD B A, ReWHM SaVic.R .tN <br /> 03-03-001 ON91TE WASTEWATER PERMIT <br /> I Y!2gW3 <br />