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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT
<br /> SAN JOAQUIN COUNTY ENVIRONmmAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 85202-(209)468.3420
<br /> NoN-REFUNDABLE PER IT CALL W9)95:3-75 FO INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED
<br /> JOB ADDRESS Cr
<br /> CROSS STREETAPN Y✓ PARCEL SIZE ✓r
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<br /> OWNER NAME t..,,s•`"�/b "�(� � _. �,....... ..�.�.PHONE y
<br /> j OWNERADORESS i".✓ .,.: CITYISTATE/Z1P ..
<br /> CONTRACTOR 'iJ'*w'Y'�(..,.. f,.r't ,,,.,..2.,. '✓r'` .-�f!'GetG 'ZJl ,L�":v PwONE V 1 ( 1
<br /> CONTRACTOR ADDRESS L CITYISTATEIZIP t"
<br /> LICENSE ,, -42 i7C-38 OTHER NU6ABER EXPIRATION DATE
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<br /> MATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coard S X Y
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<br /> r C1 PERC TEST # :. 8UILDiNG PERMIT# LAND USE APPLICATION#
<br /> TYPE 17 c� NEW INSTALLATION is REPARVADDIDON £a ENGINEER DESIGNED(ALTERNATIVE
<br /> [, REPLACEMENT 11 L7DT-OF-SEaviCE SEPTIC SvsTEMDESTRUCTION
<br /> INSTALLATION WILL SERVE: Cl RESIDENCE COMMERCIAL
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<br /> 3 OTHER —�
<br /> NUAIBBR OP LIVING UNITS: "J" t ,_ NUMBER OF EMPLOYEES: ;
<br /> e SEPTIC TANK TYPFJW43 CAPACITY�.� 981 #OF COMPARTMENTS
<br /> GREASE TRAP TYPE/MPG CAPACITY I,YZ ilei #OF COMPARTMENTS
<br /> DISTANCE TO NEAREST: WELL ! ft FDiJNDA.TIDrJ ft PROPERTY LINE ft
<br /> 0 LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM)
<br /> LEACH LINES 0 LEACHING CHAMBERS #OF"LINES _ LENGTH Of LINES ft l
<br /> DISTANCE TO NEAREST WELL � � fl POUNDATtON. I 0� ft PROPERTY UNE �✓�w'� -N
<br /> rJ FILTER BED WIDTH R LENGTH it DEPThI ft
<br /> DISTANCE TO NEAREST WELL ft FOUNDATION_ it PROPERTY UNE ft
<br /> D MOUNDED WIDTH ft LENGTH R DEPTH ft
<br /> DISTANCE TO NEAREST WELL it FOUNDATION 4 PROPERTY LINE ft
<br /> U SUMPS WIDTH ft LENGTH it DEPTH h
<br /> DISTANCE TO NEAREST W A, ft FOUNDATION it PROPE14'Y LINE it
<br /> L1 DISPOSAL PONDS WIDTH ft Lr:NGTH ft DEPTH ft
<br /> DISTANCE TO NEAREST WELL It FOUhdtJ3IT'ON It PROPERTY LINE�it
<br /> SEEPAGE PITS NUMBER V_ WIDTH ft DFPTN 1.S�
<br /> DISTANCE TO NEAREST WELL '?,CQt It FLI IN .TION t It PRoPFRTY LINE 2.!wVft
<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 ADVANCE NOME REQUIRED FOR fiNSPECTIONS-PILEA$f CALL "9 953-7897
<br /> SIGNED TITLE 17�d—r DATE +� y7tl
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<br /> Application Acn Date " Area Employe-1>7#
<br /> final Inspection �W— Date C.I SPECIAL PERMIT•Approved by
<br /> Character of Sail pth of 3 Ft PIVSump"I Character:
<br /> COMMENTS
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<br /> Recei <' tars Amount Perninl e# Permit ID#
<br /> Code -. B "` s1t Remitted Se"IcsRequest#
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