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ONSITE WAS _ NATER TREATMENT SYST7I PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPAYRTMF.N'r 304 E WEBER AVE -3k0 Fl.-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL 2099)953-7697 FOR IN•SPE(:TIONS EXPIRES I YEAR FROM DATE ISSUED JoB ADDRESSy l 10 G- 60kN 1 Ci- P-cA CITY/ZIP U CA 1 CROSS STREET SCxL e-& APN O C)7 —/SC' 02— PARCEL SIZE ly /9C��S > Ft-4- Sc OWNER NAME:- ` PHONE. 01VNER ADDRESS C/ l=- Q {^C4- CiTVISTATE/LCP CONTRACTOR CONTRACTOR ADDRESS CITY/STATE/ZIP S L LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATIO ATE WATER TABLE:DEPTH: I't GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERI TEST 4 BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION. ❑ ENGINEER DESIGNED/ALTERNATIVE t1 ❑ REPLACEMENT DESTRUCTION 4 r INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LiviNG UNI'T'S: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: f ❑ SEPTIC TANK TYPI;/MFG CAPACITY gaI #OF COMPARTMENTS ❑ CREASE TRAP TYPL/MFG CAPACITY gal #OF COMPARTMENTS ❑ PK(-,TX PLANT DISTANCE"rO NEAREST: WELL Il )UNDA'Ll( f1 PROPERTY LING It ❑ 1J1+'I=STATION S!/E: i'YPEOF 1'unli' i ❑ "AND ) L SEPARATOR(ENc:Lost:D SYs"I,FM) ❑ LEACH LINES ❑ LEACHING CHAMBERS N OF LINES LENGTH OF LINES It DISTANCE TO NEAREST WELL ft FOUNDAT]O\` ft PROPERTY LfNF ft ❑ FILTER BED WIDT14 R LENGTH fl DEPTH DISTANCE•1.O NEAREST WELL ft FOUNDATION f[ PROPERTY LINE. (j ❑ MOUNDED WIDTH It LENGTH ti DEPTH ft 1 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft n` ❑ SUMPS wim"I ft LENGTH R DEPTH DIS'FANCK-FO NEAREST WELL Il FOUNDATION PROPERTY LING ft L3DISP05AL PONDS WIDTH11 LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION R SEEPAGE PITS NUMBER PROPERTY LINE ft ^ f ❑ WIDTII ft DEPTH fl DISTANCE To NEA REST WELL 11 FOUNDATION fl PROPERTY LINE ft m 1 1 HEREBY CER'T'IFY THAT I 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. �\ 1 I ji?JM 24 HOUR ADVANCE.NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 _ SIGNED i/r" /✓ f— — TITLE 117[y DATE os !-4 1 � 1 .1 � . r +1 1 V� `f t 1 i r I p A Al. C/ DEPARTMENT USE ONLY Api liCalion Accepted 11v. -/ 1� r� Arca -- --- Emplayce ID# Dale Final lospecliun li}' Date 1 ❑ SPI:('[:\I.I'ERb'll'I'-Apprtnai by Character of Soil to Depth of 3 Ft: 1 PitISump Solt Character' COMMENTS N'- (_. PE SC Received hec Amount Permit! Invoice# Permit IDN Code iNrD H Cash Remitted rte CC Service Request# 42 ,2f C--1 I eo rti i f 42-02-Do l 12222401 ONSITE WASTEWATER PERMIT i e 1