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ONSITE STEWATER TREATMENT SYSTEII6�'ERMIT 1I' Q <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL, -TH DEPARTMENT 304 E WEBER AYE-k �-STOCKTON CA 95202-(2{19)46&34211 <br /> 11 <br /> • ' NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESe 1,91 ds <br /> r 0`nLA ti CITYM, <br /> CRoss STREET 1CJ1 (d, N ' Q �PA�RCEL SIZE ?C,-f3 b <br /> OWNER N^m C <br /> OWNERADDRESS CrrVMTATEr&P <br /> � I <br /> CONTRACTOR TO - <br /> CONTRACTOR ADDRESS - C17YISTATFIZIP <br /> I <br /> LICENSL 'A2 ❑C-36 OTHER NUMBER $RPtTU1r10N DATE <br /> WATER TABLE DEPTH:-OtT`S ft GEOGRAPHICAL INFORMATION: Coordinews X Y <br /> ❑ PERC TEST # BUILDING PERMIT'# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION -AD REPABUADDITION -;W-ENGINEER DESIGNED IALTUNATIwE <br /> O RuLACEMENT U DESTRUCTION <br /> INSTALLATION WILL SERVE; i^mMaLwee WCOM.IKROAL C3 OrHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OP EMPIAYEES: <br /> I <br /> O-SEPTICTANK TYPEIM10EXt Sh- CAPACITY gal #Of COMPARTMENTS <br /> GREASE TRAP TYPFIMfc CAPACITY 0 #OF COMPARTMENTS <br /> * PKC TX PLANT DISTANCLTO NEAREsr: WELL N FOUNDATION ft PROPERTY LINE R <br /> O LIFT STATION SITE TYPE OF PUMr ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH of LFNES R <br /> D15TANCETONHAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> Q FILTER BED W107R R LENGTH ft DEPTH ft <br /> DisTANCETONEARHST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTR ft LENGTH ft DEPTH ft <br /> DISTANCETONEAREST WELL ft POUNDAMN ft PROPERTY LINE It <br /> O SUMPS WwrH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> 13 DISPOSAL PONDS WIITnI ft LENGTH ft DEPTH ft <br /> DISTANCE TO REST WELL ft FOUNDATION R PROPERTY LrE R <br /> SEEPAGE PITS NumsER„-_ � wtm 1 �Y ft DEPTHft <br /> DISTANCE To NEAREST WELt��ft FoUNDAT10N 10+ a PRCPP.RTY LINE ft <br /> I HEREBY CERTIFY THAT I RAVE PREPARED TH15 APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAH IOAQUIN COUNTY <br /> ORDINANCES.STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 21 HOUR.ADVANCE NOTICE REQUIRED FOR INSPECTIONS-/PLEASE CALL(209)453.7647 <br /> SIGN i•L�) TITLE CJ DATE <br /> Eel <br /> T <br /> 9A ZW <br /> 10 <br /> p IN <br /> Ell <br /> ENV Rx" <br /> DEPARTMENT USE ON Y <br /> Application Accepted By Dak �' 0 Area Employee IDN X19 y <br /> Final Inspection By Date 0 SPECIAL PERMIT-Approved by <br /> Ck--cler of Soil to De Pk/Sump Solt C3aracter: / <br /> C MME14TS - 7rhe ei <br /> i 1b,c <br /> PE SC ve <br /> Receld Ch-ldi! Amount Per <br /> Cade INFO B as Remitted Date c uest# Inv Permit iD# <br /> dsna <br /> i-02- 1 �� .moi. ��- i �-x o� <,°�� MIT <br /> c, c <br />