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Zia � - <br /> ONSITE WAST"WATER TREATMENT SYSTFM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH Dk, ,,TMENT 304 E WEBER A-..W3"'FL-STOCKTON CA 95202 - (209)468- 420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR/INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1�S'� 4<-1 / CITY/ZIP <br /> CROSS STREET ` APN 1(716; PARCEL SIZE 10 o <br /> OWNER NAME Q �FL _ �G~1" PHONE <br /> OWNER ADDRESS � "��L CITY/STATE/ZIP <br /> CONTRACTOR �/V 1. PHONE. <br /> CONTRACTOR ADDRESS / (o'�'� /�' /�` CITY/STATE/ZIP ` <br /> LICENSE C-42 LJ C-36 OTHER NUMBER 2z- ) EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE O <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ZrRESiDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF ENIPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE tt <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS L(Yt S #OF LINES _� LENGTH OF LINES `` y ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ISPOSA NDS WIDTH ft LENGTH ft DEPTH_ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS WIDTH ` ft NGTH ft DEPTH 2S� ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 1�-- ft PROPERTY LINE ®�! + ft <br /> I HEREBY CERTIFY I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> TATE LAWS AND RU D REGULATIONS OF SAN JOAQUIN COUNTY. <br /> IN UN 4 HO V NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGN' TITLE �� DATE '9, <br /> -------------- <br /> NJr <br /> IT <br /> - C I <br />