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ONSITE WAS' TER TREATMENT SYST l PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH4 , RTMENT 600 E i,_._i STREET-STOCKTON CA 95202-(209)468-3426 4 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED', ` JOB ADDRESS CITY/ZIP _ Lab I I; CROSS S'T'REET _. 5IC4 h t- Lr=_. APN 0 SS 7r'+ 600-3 PARCEL SIZE OWNER NAME -y 1V� 7 l J JLC�A S A FSI �.Il.Lr 4 PHONE OWNER ADDRESS r1 � _ R l"ti}j>7 1 CITY/ST I TEIZIP y CONTRACTOR Y\A LL PHONE /� CONTRACTOR ADDRESS _. a t/ 1 (a CITY/STATE/ZIP LICENSE © C42 0 C-36 OTHER A NUMBER EXPIRATION DATE zo ~ k r WATER TABLE DEPTH: ft GEOGRAPHICAL IINFORMATION: Coordinates X X O PERC TEST # BUILDING PERMIT# --0&© F&LAND USE APPLICATION# ' 6 TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION O ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: 0 RESIDENCE M-L MMERCTAL 17 OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: / nnii^^'11 NUMBER OF EMPLOYEES.- SEPTIC MPLOYEES:SEPTIC TANK 'IYPFIMFG �APACITY ( �l It J gal #OF COMPARTMENTS © GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL Z00 PiA 4L ft FOUNDATION ft PROPERTY LINE ft LIFT STATION SIZE TYPE OF PUMP © PKG TX PLANT D SAND OIL SEPARATOR(ENCLOSED SYSTEM) O LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEA17ST WELL ft FOUNDATION ft PROPERTY LINE ft i FILTER BED( ) WIDTH ft LENGTH �� ft DEPTH DISTANCE TO NEAREST WELL I -Z&() t ft FOUNDATION ft PROPERTY LINE ft O MOUNDED WE ft LENGTH ft DEPTH ft -� DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 0 SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft O DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 0 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE T6 NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY 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. M IM Z;��OUR OTICE REQUIRED FOR INSPEC IONS-P ASE CALL 09)-953-7697 `- SIGNED �� TITLE_ Ae: (C� ��t DATE F J O A - �- - i An. - l iCTI Igw)�1! tDEPARTMEN US ONLY Application Accepted Date Area Employee ID# S � �`� Final Inspection Date ❑ SPECIAL PERMIT-Approved by Character of Soil to a of 3 Ft: pit Sump Soil Character: } COMMENTS -X446 ..tG 78 Ac-Ew 44-Cj ucw �S'7 -M ( ICs. �t7 e.T1--f r4��.0 c�J�.a ,4�f�4 G�-c� Ct�.�t�. '%Z�r.J •„� A ��<�� 2 !fVc-tES his Lrs� Cl3�y�c2ST D� r�E 4T r4`� �'ac?fl�M Fr >�c� i � _ PE SC Received Amount Date Permit/ Invoice# Permit ID# Code INFO B Cash Remitted Service Request# 42-01 aIfE WTEwa�TER PERMIT { n<nnnnn� r