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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE PERMIT G W` 1 J CALL 209 953-7697 FOR INSPECT70NS // EXPIRES 1 YEAR FRgm DATE ISSUED <br /> JOB ADDRESS_ 1�le /� s ._ CtTy(LP '19C <br /> CROSS STREET <br /> SON 1 LL SI APNZ3�— O(,Q^ I Q PARCEL SIZE YD A'— <br /> �~ O <br /> OwNEH NAME C i t v y t/ -gym ti s Fo2D y 3z�� <br /> PHONE_ +� <br /> OWNER ADDRESS CITY/STATE27P y <br /> CONTRACTOR (()r t A) <br /> PHONE <br /> CONTRACTOR ADDRESS _ CITYlSTATEaIP <br /> LICENSE QC-02 ,C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: fI GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> .7 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# - <br /> TYPE OF WORK: NEW INSTALLATION X REPAIRIADORION D ENGINEER DESIGNED IALTERNA E <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM 194 DESTRUCTION. <br /> INSTALLATION WILL SERVE: Qi RESIDENCE L1 COMMERCIAL �{ - OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPFJMCG P,L L 7 PACITy IZOO .� <br /> gal #OF CCMPAR7MENTS�_ <br /> D GREASE TRAP TYPE/MF -- <br /> T CRAP —/y-- gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST:(WO L _/OO --J" fI FOUNDATION f( PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP__ _ _ _. ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> NES LEACHING CHAMBERS ' #OF LINES LENGTH OF LINES /vKy r ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE fI <br /> ILTER BED DTH 16 ft LENGTH L�)L ft DEPTH !R �—tt <br /> DISTANCE TO NEAREST W'LL r1J2)'- ft FOUNDATION ft PROPERTY LINE ft <br /> tot) <br /> ❑ MOUNDED WIDTH ._............_.._......._........ ._ft DEPTH........,_.._._.V.-____ n <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY U_NE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH If <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH _ft DEPTH It <br /> DISTANCE TO NEAREST WELL If FOUNOAMON ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER - WIDTH IS DEPTH it <br /> — DISTANCE TO NEAREST W"'-L--ft FOUNOATION ft PROPERTY LINE................... .._ft <br /> 1 HEREBY CERTIFY THAT I 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 /> MINI UM 24 HOUR ADVANCE NOTICE RECUIREO FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED <br /> TITLE DATE <br /> I <br /> I _ <br /> Q I C U <br /> OEPA RTMENTUSE <br /> Application Accepted B NA7fyfr Date_1p� L _. _.. ;,,ea 42°� ��� Employee to,,k�74.4,, _, --c <br /> Final fnspectlon By _ Date �o SPECIAL PERMIT-Approved by <br /> Character of Soil to th of 3 Ft: P Sump Soil Character: <br /> COMMENTSd <br /> -�n,. ny,(�t s st�><r�cam•,,�i-n c�hs�_ j-10 r __-js r <br /> _ '._I <br /> PE Be Received heck Amount p� <br /> Code INFO B sh Remitted Data Service Re Rogues # invoice# Permit{D# <br /> $21 o 1 1157 <br /> 42-01 <br /> 4124/12 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />