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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue-STOCKTON CA 95205-6232-(209)468-3420 <br /> NON-REFUNDABLE PERMIT _ CALL 209 953-769_7 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> CITYIZIP G� y <br /> JOB ADDRESS <br /> ` CROSS STREET F APN PARCEL SIZE <br /> Pq <br /> OWNER NAME Viti .J„� PHONE <br /> OWNER ADDRESS � 3c�+�.L� CITYISTATE/ZIP <br /> CONTRACTOR /Y 1, I�^C S �,�;� PHONE 4;:,—2 +4 v-!� <br /> CONTRACTOR ADDRESS �l'1 1 Y l t7 �� CITYISTATEIZIP �r�I ✓- <br /> LICENSE i--C-42 LjC-36 OTHER NUMBE EXPIRATION DATE l5 ILI' <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 1 PERC TEST # BUILDING PERMIT LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ENGINEE DESIGNED IALTERhATIVE <br /> U REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: r/KESIDENCE COMMERCIAL - OTHLqt--"- - — <br /> UMBER OF LIVING UNITS: v NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPEIMFG CAPACITY gal gal #OF COMPARTMENTS_ <br /> GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> 1 <br /> DISTANCE TO NEAREST: WEL'.. _ it FOUNDATION IA) ft PROPERTY LINE <br /> iJ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTI-I ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIN[ It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> D SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 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 /> M IMU 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED �rH� TITLE C {I DATE .� ) -3 <br /> 3 <br /> 0 <br /> N � <br /> :r <br /> kr 7 <br /> r <br /> Slil -H <br />