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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT j <br /> SANJOA OATOUNTY ENVIRONMENTAL HEALTH DEPARTMENT 314E WEBER AVE-3"PL-STOCKTON CA 95202-(� <br /> NOWkIEFUNIDABLE PERMIT CALL(209)953.7W jNSPECTIONS EXPIRES I <br /> YEAR <br /> FROM/DJOBADDRESS <br /> � I <br /> •11 <br /> CROSS STREET �}I/V ^} <br /> APN PARCELSIZE <br /> 'f c d <br /> OWNER NAME Sr V PHONE 9.G,/ <br /> OWNER ADDRESS - <br /> - Crrr1STATEIZIP <br /> I <br /> CONTRACTOR r..r(/. <br /> PHONE <br /> CONTRACTORADDRESS � /' C]"EWSTATOZIP <br /> LICENSE ❑C-42 3C-36 OTHER NUMBfiR ��T � EXPIRATIpN <br /> WATER TABLE DEPTH: H GEOCRAPHIGLINFONMATION: CBOrdiBRl" X y 1 <br /> I ❑ PERG TEST(S) NUMBER LAND USE APPLICATION# - <br /> TYPE OF WORK: ❑ NEW INSTALLATION O REPAiWADDITION <br /> ❑ EN'CINEER OF.S{CNfp(A LTERNgTIYE <br /> D° REPLACEMENT ffi DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE i ❑ COMMERCIAL Q OTHER <br /> NUMHEROF LIVING UNITS: <br /> - NUMBEROP BEDROOMS: NUMBE0.OF EMPLOYEES: 2 <br /> $ SEPTIC TANK TYPEIMFO a�i)G/C�-C, CAPACITY �g,6 <br /> gel #OF COMPARTMENTS � 4 <br /> ❑ GREASETRAP TYPEIMFG CAPACITY - 9-I #OFCOMPARTMENTS .0 <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL . .5 R FOUNDATION -Z-4 1 <br /> R PROPERTY LINE� R <br /> ❑ LIFT STATION SITx Tree gFFPump ❑ SAND OIL SEPARATOR(ENCLOSRD SYSTEM) <br /> f I Ikv. <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> R <br /> Ek Du;TANCETON'EAREST WELL R FOUNDATION R PROPERTY LINE R <br /> FILTER BED W—H �? R LENGTH ..... DEPTH ( it <br /> 13r� <br /> DISTANCE TO NEAREST WELL��� _R FOUNDATION JO ft PROPERTY LfNE ,rPTy R 17'MOUNDED W—H ft LENGTH R OEH n <br /> 6 <br /> I: DISTANCE TO NEAREST WELL.1 R FOUNDATION R PROPERTY LINE f; <br />' ❑ SUMPS Vim ft LENGTH R DEPTH <br /> �1 DISTANCE TO R FOUNDATION <br /> NEARYSC WELL - R <br /> R <br /> "❑ Dl$POSgL PONDS WmT'H ft _fl <br /> R PROPERTY LINE <br /> R DEPTH <br /> n <br /> DISTANCC 70 NEAREST weu R FOUNDATION , PROPERTY LINE f1 <br /> ❑ SEEPAGE-PITS <br /> W"T" n LENGTH ft DEPTH <br /> R <br /> -f DI$FANCE TO NEhREST WELL n FOUNpATIpN R PROPERTY LINE <br /> I HEREHY C.ERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY� STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTS'. ORDINANCES, <br /> fflINIM UM 34 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(20))953-7697 <br /> SIGNED TITLE DATE / <br /> 1 <br /> 79 <br /> i <br /> 7 <br /> r <br /> 1 r <br /> h <br /> A J JIN C ON <br /> R <br /> } � r <br /> i . <br /> DEPARTMENT SE NLY <br /> ApplicafloB Accepted By .I <br /> Data Area A_ <br /> Cb Employee ID# <br /> Igeof <br /> By ' Date ❑ SPECIAL PERMIT-ApproYcd by <br /> Chanterr of SBSI ro hof h <br /> PiVSump Soil arac4r. <br /> COMMENTS y^j <br /> PE SCReceived Check Amount permit! <br /> Code IN_ B CRFRRemif d Uate <br /> Service R uest# IRvo.ce# Permit ID# <br /> f $ <br /> pl <br /> 42-0I-0PI <br /> 2R B2 <br /> ONSITE WASTEWATER PERMIT <br /> 1 <br />