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r <br /> 3`OZ' ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT ____ __CALL(209 95 -7697 FORINSPECTIONS^ EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITYIZIP AZ— L <br /> CROSSSTREET <br /> 1 A�PN � SI q 3�qPARCEL SIZE 0.y A <br /> > <br /> OWNER NAME \J e(Fv ^2 PHONE )2 )-2D5 T <br /> OWNER ADDRESS K CrrY/STATEIZIP (A• jS2-(O z <br /> � <br /> CONTRACTOR _._ PHONE <br /> 1 II r , :2L <br /> CONTRACTOR ADDRESS CITYISTATElZIP r)A,, <br /> i <br /> LICENSE I.IC-42 �,C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> � ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> i TYPE OF WORK: D NEW INSTALLATION ❑ REPAIRIADDITION - ❑ ENGINEER DESIGNED(ALTERNATIVE <br /> ❑ REPLACEMENT _ ❑ OUT-OF-SERVICE SEPTIC SYSTEM C_DESTRUCTION <br /> I INSTALLATION WILL SERVE; ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> ' ! ❑ SEPTIC TANKWNG UNITS: (� <br /> , NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: f _ <br /> NUMBER OF LI `� <br /> TYPE/MFG E'K4�N 4 CAPACITY gal #OF•COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE 11 <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> =a . LEACH LINES D LEACHING CHAMBERS #OF LINES LENGTH OF LINES` ft t�„ <br /> I" 1 '1 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft !•-. <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It }� <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft {t 1 <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATICN ft PROI'tRTY LINE h <br /> ❑ SUMPS WIDTH ft LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST,r WELL ft FOUNDATION it PROPERTY LINE ft <br /> LI DISPOSAL PONDS WIDTH 1 it LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER �— WIDTH - ft DEPTH Z S ft <br /> DISTANCE TO NEAREST WELL t D b ft FOUNDATION 00 ft PROPERTY LINE <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 /> MINIMUM 24 HOUR 4DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED------F G. TITLE. CT-v-f\B'/A—A4 <br /> S t <br /> 3 r - <br /> rL3,d <br /> v\' B <br /> �- r <br /> Ai;plicztion A= - _ _---0ate_AMD <br /> Area T Employee ID# <br /> I Final InspecUorTBy .�I' Date_ L PECIAL PERMIT-Approved by ( �.�. <br /> Character of Soil tp�Depth of 3 Ft; PiV ump Soil Character: <br /> COMMENTS 'vn I S15 <br /> PE SC 1 Received Che k#! Amount Date Permit/ Invoice# Permit IDX <br /> Codd INFO B ash Remitted Service Request# I <br /> I <br /> 242.x, L �a <br /> ` ONSITE WASTEWATER 7RTMNT SYSTEM PERMR <br /> ``\\\9721110 <br />