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1 ONSITE WAST�`NWATER TREATMENT SYST�lp+�lZ PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DL .�tTMENT 304 E WEBER Al.. =y 3N'FL-STOCKTON CA 95202 - (209)46$-3420 <br /> NON-REFUNDABLE <br /> EEJ PERMIT j �1 CALL(209)953-•7697 FOR INSPECTIONS EXPIRES l YEAR FROM DATE ISSUED <br /> / L/ 1 <br /> JOB ADDRESS R 4 Ct ITYYIIZIP 'S7 ;ne9G 7r AF <br /> m <br /> CROSS STREET `. y o _ _ APN C.V t W ! 10 r J� PARCEL SIZE 4-o � <br /> d <br /> //� ) f �. O <br /> OWNER NAME /�^'^1. �✓ PHONE h w /J 6 �2 ri <br /> OWNER ADDRESS CITY/STATEIZIP <br /> CONTRACTOR --�jPHONE __r?S-,Lf,j3 I J <br /> CONTRACTOR ADDRESS/ L7. /�C //�112•L CITYISTATEIZIP /// P,J ' � ���• { �.�T <br /> ` , ) <br /> LICENSE LJ C-42 El C-36 '� OTHER NUMBER C .) y�� EXPIRATION DATE / /-?6/03 <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 s <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE 1W COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES:\ <br /> r <br /> ip SEPTIC TANK j' TYPE/MFG 46CAPACITY S"- ZcU a 0 gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft w <br /> ❑ LIFT STATION SIZE TYPE ORPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> IN- LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES 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 R 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 /> r. <br /> ❑ DISPOSAL PONDS WwTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> a SEEPAGE PITS WIDTH zr* ft LENGTH X ft DEPTH 7 ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)953-7697 <br /> SIGNED TITLE DATE ?'DC>,7 <br /> NEW 95'LEACH LINES <br /> 4 SEEPAGE PITS <br /> .a <br /> X: <br /> �,•' :4 <br /> =XISTING 95' <br /> -EACH LINES <br /> SEEPAGE PITS e <br /> c ,:c <br /> O <br /> a �+ <br /> Z S <br /> 3—WAY AUTOMATIC O <br /> = plsTRrsuTION VALVELLJ o w <br /> . ,.,, } <br /> z <br /> ExlSTINC, NEW(5)20007, ¢ o <br /> (2)2m0s 6AL.TAI4CS z <br /> GALT L p' <br /> -- .__.. <br /> DEPARTMENT.USE ONLY- <br /> I Application Accepted B Date '10)k Area Employee ID# { <br /> Final Inspection Date ��ZD�d� ❑ SPECIAL PERM]f-Approved by <br /> Character of Soil to De of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> 4141 <br /> PE SC Received Check#1 Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 13! 5-1-L -722S 990 5-lo-03 d 33 926 <br /> 1 42-01-001 ONSITE WASTEWATER PERMIT <br /> 1212102 <br />