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ONSITE WASTEWATER <br /> SAN JOAQUIN COUNTY ENVIRONMF,NTAI.HEALTH DEPARTMENT TREAT <br /> NON-REFUNDABLE PERMIT TREATMENT SYSTEM PERMIT <br /> CALL(209)953-7697 304E YYEBERAVE-J1OFL-STOCKTONCA95202 _ <br /> 1—jol <br /> ADDRESS — O``t� FOR IN's CA (209)468-3420 <br /> CROSS STREET <br /> EXPIRES I YEAR FROM DATE ISSUED <br /> Cr v/ZIP—ILT Z� <br /> 1 • v <br /> OWNER NAME /VL°l�s/lC wPN (/(/�_�� �� R <br /> OWNER ADDRPSS 4' ' ''� � - PA NOEL SIZE ,3�g�C b <br /> s S o <br /> G c: L <br /> CONTRACTOR CITY/STATF/ZIP e- — <br /> r� nl ism A S <br /> CONTRACTORADDRpS,S ! Q2 <br /> �• G C� PHONE <br /> LICENSE ❑C.-42 CITY/SPATE/ZIP �1 S� <br /> OC-36 OTliI:R / fre'Va� <br /> WATER TABLE DEPTH:_ NUMBER_ LLQ <br /> fl GEOGRAPIIICAL INFORMATION: Coordinates X FxPI'—RATION L <br /> ❑ FERC TEST(S) NUMBER y _ <br /> TYPE OF WORK: -- LAND USE APPLICATION# - <br /> ❑ NEW INSTq LI.ATION <br /> 1.1 RF.PAIRJADDITION F.NGI ER 1 NEO/ LTF.IL <br /> ❑ Ri%,AC.F.MENT I� ryE ] E� <br /> INST�LIVING <br /> DESTRUCTION <br /> ❑ RESIDENCE ❑ COMMERCIAL Cj <br /> ❑ OTI{EN__ <br /> NUMBER OF BEDROOMS; h'u MBER OF EMPLOYEES: <br /> Ll SEPTIC TANK TYPE/MFG <br /> CAPACITY _ Qa) #OF COMPARTMENTS <br /> ❑ CREASE TRAP TYPE/MFG_ CAPACITY <br /> Qal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCETO NEAREST: WELL ft FOUNDATION It PROPERTY LINE R <br /> ❑ LIFT STATION SI7,F. TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES _ LENGTH OF LINES rt <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE fl 1 <br /> ❑ FILTER BED Wiwm _ ft LENGTH R DEPTH _ R <br /> DISTANCE TO NEAREST WELL, — ft FOUNDATION R PROPERTY LINE <br /> ❑ MOUNDED WIDTH R LENGTH ,fl DEPTH R <br /> DISTANCE TO NEAREST WELL--ft FOUNDATION_ ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTii fl DEPTH _ ft <br /> DISTANCETONEARF.ST WELL _fl FOUNDATION__11 PROPERTY LINE__ ft <br /> ❑ DISPOSAL PONDS WIDTH fl LENGTH __ ft DEPTH ft <br /> DISTANCE TQ NEAREST WELL __—D FOUNDATION R PROPERTY LINE _ ft <br /> . _- <br /> C3 SEEPAGE PITS WIDTH fl LENGTH (( DEPTH R <br /> — it <br /> DISTANCF.TO NEAREST WELL 6 FOUNDATION -it PROPERTY LINE <br /> 1 HEREBY CERT 'E PREPARED THIS APPLICATION AND THE WORK WILT.BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE.LAWS AND RULES AND REGC I.ATIONS OF SAN JOAQUIN COUNTY. <br /> MUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECT41ONS-PLEASE CALL(209)953-707SIGNED <br /> TITLE DATE <br /> , <br /> V'N' <br /> it <br /> +� J- �\�\. r'E� ' • !fir Q Q r <br /> DEPAUSE NLY / <br /> Datete Area_.�� <br /> Date Employee IU# .-�•i2K._� <br /> Application Accepted BY - f ❑ SPECIAL PERMIT-Approved by _ <br /> Final Inspection BY It/Su mp Soil Charact r: <br /> Character of Soil tE� epth o <br /> COMMENTS <br /> 2 0V <br /> PE SC Received C <br /> Code InFo By C-1, <br /> ,v ? Db3 r <br /> ,pd r F1��� 1�.i R>1 Imo <br />