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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT J/JI/1 /� <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 951U09)468-3420 <br /> NON-REFUNDABLE PERMITCALL(209)953-7697 FOR INSPECTIONS /1 EXPIRES 1 YEAR FROM DATE ISSUED <br /> ITY/ZIP r- <br /> JOB ADDRESS F I COf/ (A4 q ' <br /> �� f <br /> /w� IIS <br /> n �- bL1�� fin <br /> CROSS STREET iJ�L(GII4 APN C7�I I [� 3 PARCEL SIZE < <br /> 0 <br /> OWNER NAMETO(l't FCC--1K h PHONE <br /> OWNER ADDRESS SG"K'i'/ CITY/STATErbP /' Q/ <br /> CONTRACTOR, k G`k jbC�t+ I SL PHONE Lf - SV <br /> a <br /> CONTRACTOR ADDRESS (9 S-A CITYISTATE/ZIP +CYI C.L L-'} 1e44 <br /> LICENSE 1 C42 -�C-36 OTHER NUMBER-EXPIRATION DATE <br /> 1 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> rl PERC TEST # BUILDING PERMIT# �p O LAND USE APPLICATION# __ <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE ' <br /> C REPLACEMENT I DESTRUCTION , <br /> INSTALLATION WILL SERVE: P--RESIDENCE COMMERCIAL _ OTHER <br /> NUMBER OF LIVING UNITS: C NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG _ CAPACITY 20 A a gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL _ -D(0 R FOUNDATION 16' R PROPERTY LINE 3e)1 R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> EACH LINES LEACHING CHAMBERS #OF LINES L4 LENGTH OF LINES q6' it <br /> DISTANCE TO NEAREST WELL —�5cR FOUNDATION s"rA I R PROPERTY LINE_ -An( it 1 <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH tt "1 <br /> DISTANCE TO NEAREST WELL R FOUNDATION tt PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH tt <br /> - DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE it <br /> WS1 <br /> �/SUMPS WIDTH � R LENGTH ',�. R DEPTH IQf it .� <br /> DISTANCE TO NEAREST WELL I�_it FOUNDATION -"rnt R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH tt LENGTH R DEPTH it <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTYUNE R m <br /> ❑ SEEPAGE PITS NUMBER WIDTH ---- ft DEPTH _- _____ ft 1 <br /> DISTANCE TO NEAREST WEL L R FOUNDATION ft PROPERTY LINE tt <br /> I 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 /> '1r1 NFFF���OOOURAIIMUM 24ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> ` TITLE Ct) C G'I'(T DATE 3 O it <br /> I <br /> tL <br /> 7 <br /> I <br /> iIT <br /> lw <br /> t I .:rot 4�'w a _ 4r h�' 1 A <br /> .+ <br /> ��� ..- _....�BEPART Y`IENeT7U -- <br /> ApplicationAccep Date 6 ,3 0 Area Employee ID# / C, <br /> Final Inspection >. T Date �yU SPECIAL PERMIT-Approved by / <br /> Character of Soil to pth of 3 t: Pit/Sump Character: <br /> COMMENI 1, C-o7-0>F ,P�CoQQ ,S�c,�r09 LeA-A)gSot t_ *7- <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO I 13Y Cash Remitted Service Request IN <br /> 42 r/ !/ 3 5 q^ `fSp DC7 a t <br /> I I <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 10/4/07 <br />