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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202.(209)465-3420 k <br /> NON-REFUNDABLE PERMIT CAL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZIP w ' <br /> CROSS STREET APIN 6 PARCEL SIZE b <br /> OWNER NAME PHONE g_� <br /> OWNER ADDRESS CITYISTATEiZIP Q <br /> CONTRACTOR PHONE <br /> I <br /> CONTRACTOR ADDRESS CITYISTATEIZIP I <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> n PERC TEST # BUILDING PER # O LAND USE APPLICATION# A` <br /> TYPE OF WORK: ❑ NEW INSTALLATION 7 REPAIRIAODITION C ENGINEER DESIGNEDIALTERNATIVE 1_ i <br /> ❑ REPLACEMENT C DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: { <br /> SEPTICTANK TYPFJMFG CAPACITY117LI29 gal #OFCOMPARTMENTS � <br /> C1 GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELLft FOUNDATION ft PROPERTY LINE ft <br /> 0 LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT U SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES G LEACHING CHAMBERS #OF LINES LENGTH OF LINES b ft <br /> DISTANCE TO NEAREST WELL IC30 ft FOUNDATION J0 ft PROPERTY LINE 15;7,A1&1 ft <br /> Q FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION____,___, ft PROPERTY LINE_____ ft <br /> O MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br /> O SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> 0 DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEA EST WELL R FOUNDATION-___ _ ft PROPERTY LINE fI <br /> 10 SEEPAGE PITS NUMBER �' WIDTH — ft DEPTH �1 ! ft <br /> DISTANCE TO NEAREST WELL_Zft FOUNDATION /1/�ft PROPERTY LINE��AIlA R <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 /> MI UM UR ADVANCE NOTICE REQUIRED FOR INSPECTI NS-PLEASE S&L(209)953-7697 / <br /> SIGNED � TITLE 'AaDATE 10--91–m <br /> (E)1200 gal SEPTIC TANK I <br /> g'� + I (E)1200 gal GREASE TRAP <br /> �o-}_ ------- <br /> - <br /> 121 <br /> a,,.�• .�a 1-1r _ .tYAGklv'.. TEMPLE <br /> ------ — _L o - <br /> ———— y--- <br /> E S�B1GE- L--- -- ----- <br /> / u-3� <br /> -y T__._ T_ (N}1 �0 gal S TIC TANK �A ENT <br /> 1-71 I -._- RFC <br /> W ED <br /> EPA <br /> R71VlE <br /> Application Accepts Date Area mptoyee ID# —1 <br /> Final Inspection Date U 4J ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil topth of 3 Ft: Plt/Sump Sall Character: <br /> COMMENTS �774LF;(t` ?l�/l7ST�Sri`�� / / ! � I LCr.G�1F�7Z7yC1) <br /> I <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B Cash miffed Date ice Request_# Invoice# Permit ID# <br /> 0 <br /> 42-01 ONSTTE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 1014ID7 <br /> r4 <br />