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i <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)465-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> J Csls.._ L_ <br /> JOB ADDRESS :X /F �C _ CITYIZI}P/� �/•f� <br /> {{ G 05 O / 0 �J PARCEL SIZE <br /> CROSSSTREETn - J�Y-D/VQ A(PN/..//- <br /> OWNER NAME CA ` �/ �` I��� _d_2� ! PHONE <br /> OWNER ADDRESS D O A Lb L�j F.� 'SAC CITYISTATE/ZIP <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITYiSTATEJZIP <br /> LICENSE QC-42 QC-36 OTHER NUMBER EXPIRATION DATE <br /> t <br /> WATER TABLE DEPTH: CP_10 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> C PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: C NEW INSTALLATION YIREPAIR/ADDITION C ENGINEER DESIGNED IALTERNATNE <br /> C REPLACEMENT LI OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION L <br /> INSTALLATION WILL SERVE: SIDENCE D COMMERCIAL Q OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> T n/(^�� <br /> El SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEWPG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TONEAREST: WELL ft FOUNDATION It PROPERTY LINE k <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> &I—LEACH LINES L LEACHING CHAMBERS #OF LINES ^� LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL --k FOUNDATION J,l ft PROPERTY LINE 7 It <br /> ❑ FILTER BED WIDTH - ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH k LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL �1 ftFOUNDATION ft PROPERTY LINE ft <br /> ❑ sumps WIDTH LENGTH / ' ft DEPTH I It <br /> DISTANCE TO NEAREST WELL 1,ZZ ft FOUNOATION I'D ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY L:NE It <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 /> MINIVOM 24 HOUR AaMAWCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE �l'S DATE A�/J <br /> - I <br /> I U0 <br /> 150 <br /> Wy <br /> I <br /> 11 <br /> D'EhARTMENT USE Y , <br /> Application Accepts DateV. Area Employee lD# <br /> Final Inspection i Date C SPECIAL PERMIT-Approved by <br /> Character of Soil to epth o 3 Ft: PiVSump Soil Character: <br /> COMMENTS <br /> S <br /> / / �. �J. -.i✓-., �`_�3—:U --�,f 7r'rr,-, .ami <br /> PE SC Recelved Check#/ punt Date, Permit <br /> Code INFO 8 Cash RemittedService Re nest# Invoice# Permit ID# <br /> 42-01 P`4., `.4. Q-,r-.,_�" ✓ �6 ,s ONSITE WASTEWATER TRTTMNT SYSTEM PERMIT <br /> 9!21110 �Lr .�tG�!'t`nA� C� "� JUec✓ /c=.-C��7�� <br /> � 'f'/�-�r�2.�✓5/�.tr�:01�sit:� � -_, Td �—�sc.�.�:vt��<.�.czse�►�.�-�x <br />