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//V/= y` rz Tv,xA\ 5a� to-7-I6 Qyr <br /> );r7 - ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1888E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS E%PIPES 1 YEAR FROM DAiE ISSUED <br /> JOB ADDRESS C"y/ZjP -1 /0 <br /> .1 v+ <br /> Cam STREET )/ APN �`F �P�A/R/CELSIZE <br /> OWNEq NAME ( _ F-✓ ♦ PHONE <br /> OWNER ADDRESS O [ 4 5z <br /> />1_ _CRWSTATFJZIP `)ISN Y Z O _ <br /> CONTRACTOR .C-J/ 'rS �Ls1.stOIIAyY jf F.0 C PHONE 9J✓ /✓ <br /> CONTRACTOR ADDRE98 y�{j a� CTY/STATEZP ��X//L� les- <br /> LICENSE N� C-42 ❑,IC_�-83e778 OTHER_ _ NUMBER //OWE%PIRATIONDATE �`�IG'I Y• �1 <br /> WATER TABLE DEPTH: 1L{T R GEOGRAPHICALINFORMATION: Coordinates % Y <br /> ❑ PERC TEST s BUILDING PER MR# LAND USE APPLICATION# <br /> TYPE OF WORK: i NEWINSTALLATKIN REPMIVADORION ENGINEER DESIGNED IALTERNATNE <br /> REPLACEMENT OUT-0F-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ REsmENCE 45 COMMERCIAL L OTHER <br /> NUNBER OF LIVING UNITS: NUMBERCFBEOROOMS: NUMBER OF EMPLOYEES: <br /> SEPTICTANK TYPE/MFG t)C,lj CAPACITY gal AOF COMPARTMEMB <br /> ❑ GREASE TRAP TYPE/MFG T CAPACITY gal N OF COMPARTMENTS <br /> DISTANCETONEAREST: WELL N FOUNDATION R PROPERTY LINE N <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP Cl PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> /l LEACH LINES LEACHING CHAMBERS ,,F/ #O LINE5 LENGTHOFLINES /T/ N <br /> DISTANCE TO NEAREST WELI,/ it FOUNDATION RjQ' A- R PROPERTY UNE3�-i R <br /> ❑ FILTER BED WIDTH K LENGTH ry DEPTH R <br /> DISTANCE TO NEAREST WELL H FOUNDATION B PROPERTY LINE it <br /> ❑ MOUNDED WIDTH it LENGTH N DEPTH it <br /> DISTANCETONEARE5T WELLN FOIIIWON ry PROPERTYLLI)INE� ry <br /> SUMPS WIDTH B LE��NG�T/H1 ) fl DEPTH IIV P) h <br /> DISTANCE TO NEAREST WELL(TppK UNOATIDN JQ�I�_B PROPERTY4NE N <br /> ❑ DISPOSALPONDS WIDTH X LENGTH H DEPTH K <br /> DISTANCE To NEAREST WELL __ N FOUNDATION N PROPERTY LINE it <br /> ❑ SEEPAGE PITS NUMBER WIDTH _it DEPTH_ N <br /> DISTANCE TO NEAREST WELL It FOVAiDpTION 8 PROPERTYLME it <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINMI01M91 UQYDV E NOTICE REQUIREp FOR/NSPECTI -PLEASE CALL(209)953-7697 > <br /> SIGNED TITLE DATE Id �J <br /> rl KC O <br /> _T <br /> TT- <br /> J 4! <br /> 2 <br /> 1 <br /> W <br /> S <br /> Application Accap Oate Area D Z q Employee IDp <br /> Final tion y F - Data /Q // 6 El SPECIAL P�E�RMIT-Approved by <br /> *— <br /> Charactercteroof Soil to th o 3 FC PiMiumP Solt Character: <br /> COMMENTS S-I �p.l-w k�-4-r 5-Wrw4`f- �.> S�vAU l xu,�-a� <br /> 'w I (I - l .�L - T- ,l _ e{o v 243' -L LG =13' .) � <br /> O LAO FCJ CAP ' x abs <br /> PE SC Received CheckM Amount Dela permiU Involeea Permit lDe <br /> Code Ingo B Cash Remitted SerWce Request a <br /> Zt 25- .12 CJy•p� /-. <br /> I /' <br /> 42-0, 5>n A LLYLc�"I IA�Al1Y�+-vK o ACC¢Dds(' yy/1tG I �•k{v IQO/ / <br /> ONSITEWA EWAT T SYSTEM PERMN <br /> 424/12 <br />