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:o 30 <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN CouNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3"FL-STOCKTON CA 45202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 951-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESS st CITY/ZIP a <br /> rA <br /> // <br /> CROSS.h`I'REET COpp t APN PARCELSIZE D• C <br /> A <br /> OWNER NAME1 PHONE <br /> OWNERADDFL-SS � �Li S l�p !`,� — CITYISFATFJZIP ZZ�e' <br /> CONTRACTOR PHO <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP — a' <br /> LICENSE ❑C-02 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> F❑ PERC TEST # —� BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ MON ❑ ENGINEERDESIGNLD/ALTERNATIVE <br /> REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ;t-RESIDENCE ❑ COMMERCIAL <br /> � ❑ OTHER_ <br /> NUMBEROFLIVINGUNrrs: L NUMBER OF BEDROOMS: LJ NUMBER OF EMPLOYEFS:_. <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY ©Q gal #OF COMPARTMENTS Z <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gel #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL J R FOUNDATION ft PROPERTY LME ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LiNPs LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL R FO <br /> UNDATION ft PROPERTY LINE ft <br /> FILTER BED WIDTH 72,(N It LENGTH_5-0 _ft DEPTH -Z it <br /> ft <br /> DISTANCE TO NEAREST WELL_�_It FOUNDATION ft PROPERTY LINE 6 R <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL_ ft FOUNDATION_ R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft L.ENGTN ft DEPTH fl <br /> DISTANCETON£AREST WELL ft FOL'NDATCS ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH_ It DEPTH ft <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION ft PROPERTY LINE ft <br /> Q SEEPAGE PITS NUMBER WIDTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> !HEREBY CERTIPY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ' ORDINANCES.STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> \\ MINIMUM 24 HOUR ADVANCE NOTICE REMIXED FOR INSPECPIONS-PLEASE CALL(204)453-7697 <br /> SIGNED C�Z, 16a � TITLE u'...� �C vc-7 DAT9�--7?,• .1 _ <br /> ---XIXIXI �a�e tsa <br /> ! mwArw lsw <br /> 1m.c13 <br /> ro . <br /> + <br /> -WA <br /> uhwalvuol�wi�wv. - -- <br /> p' <br /> J <br /> �o snET <br /> Lu <br /> LU <br /> f 9y5� iv-o• a a ` ca.� a q/�d�O' ra-v/ 135 A, _ <br /> MalMal I <br /> r---r�- <br /> i UO <br /> uaoniwrwrm �---' L(— <br /> i <br /> )WASTE eerro r.� <br /> I ' �ocu�ow �c <br /> APIA(F11TFR BE i g owe <br /> i a np�Emaumosawr<A woeo„ sl PAYMEC 1- <br /> a <br /> RECEIVE!, <br /> �--�- --- a - MAR 19 LL-i <br /> SAN JOAQUIN <br /> ENVIRLWM <br /> t DEPARTMENT USE L ''7 / <br /> Applimflas cetwd /Ate+ Employee 1D# <br /> Final Iaspec By Date / ❑ SPECIAL PERMIT-Approved by <br /> Character of Sia tD Depth 3 Fr-- Ptt/Susnp Soil Chsmeter: <br /> COMM-EN Ito <br /> �8• &ZcZ;' p <br /> PF, SC Received RePrdunt Dau ��e West# Inv o(oe# Permit IDN <br /> By <br /> Crdc INPOu <br /> 12244Z-d2-ORT-'" 7'. .��-SC AC- w� .rf$!l 4� . c0 N <br /> �/PGDj�rn.,-� �.-t�"rfi �...F�✓P?'r �cvrr-7f�v)u7.'t'1 f�ib� -s.�/.�.L c�'�r'�C1`/"�'�'7�Gn 7.��-O�,Si <br />