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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 6CO E MAIN STREET-STOCKTON CA 95202-(209)468-3420 j <br /> NON-REFUND E PE IT CALL(209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS - CITYPLIP <br /> CROSSSTREET APN ` PARCEL SIZE c <br /> OWNER NAME PHON $, � <br /> OWNER ADDREW f24 t) CTTYISTATErZIP <br /> �`".J PHONE wJ� <br /> CONTRACTOR ` �A, <br /> CONTRACTOR ADDRESS 466o N � CITYISTATF/ZL*� �Y <br /> LICENSE V-42 :ICv36 OTHER 16 NUMBEAOE.P''RAT.ON DATE <br /> I <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> F, PERCTEST # BUILDING PERMIT# <br /> LAND USE APPLICATION# <br /> TYPE OF WORK: I'. NEW INSTALLATION REPAuVADDITON C ENGINEER DESIGNED/ALTERNATIVE ! <br /> REPLACEMENT ❑ OUT-PIF-SERVICE SEPTIC SYSTEM G DESTRUCTION i <br /> INSTALLATION WILL SERVE: �RESIDENCE /COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF ORCOMS: _ NUMBER OF EMPLOYEES: 1 <br /> LlSEPTICTANK TYPE/MFG� ltl CAPACITY D21 #OF COMPARTMENTS <br /> CI GREASETRAP TYPEIMFG CAPACITY _ gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTYLINE_ft � <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKGTXPLAN SA OIL SEPARATOR(ENC SYSTEM) I. <br /> LEACH LINES LEACHING CHAMBERS d'l _K7 #OF LI NGTH OF LI ES ft <br /> DISTANCE TO NEAREST WELL --ft FOUNDATION It PROPS LINE ft l <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE n <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION It PROPERTY LINE <br /> ❑ SUMPS WIDTH ft LENGTH. ft DEPTH ft <br /> I <br /> DISTANCE TO NEAREST WELL ft FOUNDATN ft PROPERTY LINE ft <br /> IO <br /> CI DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PRS NUMBER WIDTH ft DEPTH- <br /> DISTANCE <br /> EPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WrrH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI HIO I QUIRED FOR TION E CALL(209t)�95�3- 7 <br /> SIGNS \' DATE <br /> l N <br /> u <br /> SSy <br /> I ItH <br /> I L <br /> ti <br /> ILI <br /> I <br /> �. <br /> __��•� - <br /> .� 'YrR T M-E ft-T--&S-E-0 N L:y�i-- -• �r f <br /> Application Accepted Data Area -�-- Employee ID# :! <br /> Final Inspection By Data �f ❑ SPECIAL PERMIT-Approved by f <br /> Character of Soil to of 3 Ft: P' Sump Soil Character: <br /> CO ENTS <br /> PE SG Received Amount Permit! invoice# Permit IDX I x <br /> Code INFO B h Remitted Date Service Request# i' <br /> 4«-0T ONSITE WASTEWATER TRTMNT SYSTEM PERWT <br /> 6126109 <br />