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ONSITE WASVATER TREATMENT SYST" i PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DE TMENT 304 E WEBER AJ�3R"FL-STOCKTON CA 95202 - (209)468-3420 ON-REFUNDABLE PERMIT I CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED 'A N On ADDRESS e �J" `� CITY�/(ZIY �- V` =1 CROSS STREET APN T' / �� PARCEL SIZE L p p DWTERNAME ��In -r- /� `� to t'/ / 1 / rl \ PIIONE >4-� r/,��,{ >^ LCONRA RESS -2 �rLr U L 1 CITY/STATE/ZIP U C kttM (�R �f_ ,� l V r � PIIONE �( G y. :5 L4 -7 R ADDRESS (� �(" X 6 1 E(- S CITY/STATEIZIP❑C-42 ❑C-36 OTHER NUMBER V EXPIRATION DATE WATER TABLE DEPTH: 11 GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST(S) NUMBER LAND USE APPLICATION it TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTICTANK TYPE/MFG CAPACITY gal N OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal M OF COMPARTMENTS ❑ PKC TX PLANT DISTANCETO NEAREST: WELL it FOUNDATION 11 PROPERTY LINE fl ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS M OF LINES LENGTH OF LINES fl DISTANCE TO NEAREST WELL R FOUNDATION ti PROPERTY LINE (1 ❑ FILTER BED WIDTH H LENGTH it DEPTH ry DISTANCE TO NEAREST WELL H FOUNDATION R PROPERTY LINE fl ❑ MOUNDED WIDTH R LENGTH R DEPTH fl DISTANCE TO NEAREST WELL 11 FOUNDATION It PROPERTY LINE ry ❑ SUMPS WIDTH ft LENGTH It DEPTH R DISTANCE TO NEAREST WELL A FOUNDATION R PROPERTY LINE ry ❑ DISPOSAL PONDS WIDTH ft LENGTH H DEPTH it DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ry ❑ SEEPAGE PITS WIDTH it LENGTH fl DEPTH it DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R W 1 HEREBY CERTIFY THAT 1 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. ` MINNIM�/1.Sd HO,4{R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 �+ 1 IGNED��.1'r- tjllTITLE S DATE _ i z t� �w y8"Q;fs pmo' C o a f X r L \ L �.�., /'� (' EPARTMENT USt,uv. - _ - Application Accepted By 1/V/�4[JcG./ lR'`-\ 1 Do Arco Arca Employee ID# Final Inspection By Dale ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth or 3 Ft: Pit/Sump Soil Character: COMMENTS SU CWu�. PE SC Received Cbeckfl/ Amount Date Permit) Involcep Permit lDp Code INFO By Cash Remitted Service Re ucat p 4212102 12-01- ONSITE WASTEWATER PERMIT