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�. 0 <br /> bNSITEIWA EWATER TREATMENT SYS ;M PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT '} 304 E WEBER AVE -3k°FL-STOCKTON CA 95202 - (209)468-3420 <br /> ' II .� �..i �i <br /> AitSl�vhEVUNDADLE'P�RMIT 2 6' o `//`'�! CALL 269 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS `+C. Ste'. yil l2� CITY/ZIP C: ;Z'Ir.-.. y <br /> �{'�� ./ <br /> CROSS STREET �L�"" 1 APNy Z LJ iJ -" PARCEL SIZE o <br /> OWNER NAME <br /> PHONE y <br /> II! it <br /> OWNER ADDRESS '� - C - CITY/STATE/ZIP Z2 <br /> 1i 1 <br /> -CONTRACTOR PHONE <br /> 'CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> 'LICENSE ❑C42 [E ❑C-36 OTHER -'� NUMBER EXP[RATION DATE <br /> WATER TABLE DEPTH- <br /> J ft GEOGRAPHICAL INFORMATION: Coordinates X Y��._ P — <br /> e It <br /> i PERC TEST # BUILDING PERMIT# IIAND USE APPLICATION# <br /> TYPE OF WORK: ❑ lqtW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGN ED YALT911tNATIVE <br /> I,❑ REPLACEMENT �' - ❑ DESTRUCTION <br /> F <br /> STALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> �❑ SEPTIC TANK TYPE/MFG - CAPACITY gal #OF COMPARTMENTS <br /> ❑, GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> D LIFT STATION SIZE TYPE OF PUMP . ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> i <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> rt) <br /> !I DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft (T <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> "❑ MOUNDED WIDTH ft LENGTH _ ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL .,f ft FOUNDATION ft PROPERTY LINE ft <br /> D DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION t) , PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TOINEAREST WELL R FOUNDATION ft PROPERTY LINE 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 /> ;I <br /> MINIMUM 24 HOUR ADVANCE NOTICE:REQUIRED FOR INSPECTIONS-PLEASE CACL(209)953-7697:. <br /> u: <br /> SIGNED o TITLE_ �.. .�. ,- DATE ': C7 ko <br /> Sun 0M No <br /> S <br /> I S <br /> so a <br /> s <br /> DEPARTMENT USE OjVLV L, <br /> Application Accepted By `" �-Dam ' f)(1 Area Employee ID# S �� <br /> Final Inspection By Date / ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: �_�Jle p Sol]Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount ' Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Request# <br /> 42-02-001 ��/Q �Y ONSITE WASTEWATER PERMIT <br /> 12/22/2003 <br />