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ONSITE WAQ ZWATER TREATMENT SYS.ave;M PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3"°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT ` G CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ?-'77 4D cJp0yJLetD IZ,D, CITY/ZIP <br /> CROSS STREET LLt3T� �D, APN PARCEL SIZE p <br /> O <br /> OWNER NAME 1 NJV PHONE N <br /> ;n <br /> OWNER ADDRESS � wvw CITY/STATE/ZIP �J p <br /> CONTRACTOR ItEtT�l71" Q�� " LL 7�--D'K�1 I�-L �C PHONE �Ip L�Ti�SZ <br /> CONTRACTOR ADDRESS 45 t CITY/STATE/ZIP A5 <br /> LICENSE W-42 CJC-36 OTHER NUMBER 'SCI 5�8 EXPIRATION DATE a'L B <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: ��*� I f,' NUMBER OF BEDROOMS: __3 -� <br /> NUMBER OF EMPLOYEES: <br /> _. ❑ SEPTIC TANK TYPE/MFG?K//��L«��lC �T 'W � CAPACITY 007 gal #OF COMPARTMENTS Li <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> LJPKG TX PLANT DISTANCE TO NEAREST: WELL I't'�-t— ft FOUNDATION 3d/ ft PROPERTY LINE !? <br /> `7 / ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES L40 ft <br /> t S6' ft <br /> DISTANCE TO NEAREST WELL BOO '�" ft FOUNDATION �� ft PROPERTY LINE <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 R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft r <br /> EF SEEPAGE PITS NUMBER I WIDTH �j�L� R DEPTH <br /> C <br /> DISTANCE TO NEAREST WELL, Ift FOUNDATION ft PROPERTY LINE JVD I ft (� <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 14 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE DATE <br /> AKKi <br /> Rill r, An <br /> ' S J&kQLl1NCOJNFY <br /> d <br /> 0 0 <br />