|
A .i /./8
<br /> a"I ' P.-:,g ONSITE WASTEWATER TREATMENT SYSTEM PERMIT
<br /> SAN JOAQUIN COUNTY EhLYIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420
<br /> NON-REFUN RM CALL 2 953-7897 FOAlNSPECTIO� EXPIRES 1JE? ROM DATE ISSUED
<br /> Joe ADDRESS_.__ .. —._,..._.....____._..... .... CITY/ZIP__._., .:
<br /> ......_........_... ..__. .__...
<br /> t -- ... - ---- P
<br /> CROSS STREET�"'�`� -TT!.��___ APNCM PARCEL SE" _- ,._ '�
<br /> OWNER NAM
<br /> ........ ONE
<br /> OWNER ADDRESS .. .....f............ __ !V[.� ..__CffY/STATE/ZIP ...-.._..—....✓ -...__...............................
<br /> CONTRACTOR,r),��..___._.._ ......�..
<br /> ,,, h1f'A1 ;4L
<br /> vd -
<br /> CONTRACTORADDRESS „_, LO_M .� j1��........_.._---CITY/STATE/Z1P.--,. o ..Cll!!WL-I.....
<br /> '„�,'�•v�.—
<br /> LICENSE X C-42 U.-C-36 OTHER NUMBER.,�.0-051. ,__...EXPIRATION DATE— tNA
<br /> WATER TABLE DEPTH:------ it GEOGRAPHICAL INFORMATION: Coordinates X Y
<br /> i..i PERC TEST k [ BUILDING PERMIT# �,.">,.,(,� �� LAND USE APPLICATION
<br /> TYPE OF WORK: NEW INSTALLATION REPAIIVADDI7WN —ENGINEER DESIGNED/ALTERNATIVE
<br /> REPLACEMENT OUT-OFSERVICE SEPTIC SYSTEM DESTRUCTION
<br /> INSTALLATION WILL SERVE: RESIDENCE 1; COMMERCIAL ��jj� L.'1 OTHER—
<br /> NUMBER of LIVING UNITS:__.....�_.._.._._.._...._.__._.._ NUMBER OF BEDROOMS:,,,,,_,,._,,,_.,.--5W+ NUMBER OF EMPLOYEES:----
<br /> SEPTIC
<br /> MPLOYEES:__.-__,_SEPTIC TANK TYPE/MFG ,yL�,-j,j„� —F ...._,,,_._ CAPAC,11'Y gal #Of COMPARiMENTs_— _„_--
<br /> ❑ GREASETRAP TYPE/MFG _._..__.. .. CAPACITY,__.__.._ _. gal k OF COMPARTMENTS _
<br /> DISTANCE TO NEAREST: WELL
<br /> it I"OUNOATION„__
<br /> ___............... it PROPERTY LINE
<br /> ❑ LIFT STATION SIZE _._.__._..._.......TYPE OF PUMP__.-__,_—__❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM)
<br /> LEACH LINES X LEACHING CHAMBERS --- _ #OF LINES ` LENGTH OF LINES _may, it
<br /> DISTANCE TO NEAREST WELL , it FOUNDA noN— It PROPERTY LINE it
<br /> ❑ FILTER BED WIDTH —_ It LENGTH._......._........._._._._................................._�___.ft DEPTH it
<br /> DISTANCE TO NEAREST WELL __,._ it FOUNOAfiON —it PROPERTY LINE ft
<br /> ❑ MOUNDED WIDTH —�,it LENGTH ft DEPTH it
<br /> DISTANCE TO NEAREST WELL _ it FOUNDATION_„y,_•,_,_„__,it PROPERTY UNE it
<br /> ❑ SUMPS Ww”._.. __...__. __—it LENGTH ._. it DEPTH_ it
<br /> DISTANCE TO NEAREST WELL ,-_.it FOUNDATION It PROPERTY LINE.__„___— it
<br /> ❑ DISPOSAL PONDS WIDTH_,--,__„„_,...__..___it LENGTH ft DEPTH —�_ _..�— it
<br /> DISTANCE TO NEAREST WELL. It FOUNDATION it PROPERTY LINE it
<br /> SEEPAGE PITS NUMBER Lz— W it DEPTH it
<br /> DISTANCE TO NEAREST WELL. _ it FOUNDATION �it PROPERTYLINE _—it
<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 /> OXW24 lUV TJ P ONS- SE CALL f209).953-7697
<br /> SiGNED _f.... _....._.........
<br /> .._.. , TITLE_-...... DATE -..__ ..~ c._.
<br /> / J�1
<br /> l
<br /> � +
<br /> 4
<br /> MOD B IV IQ
<br /> o t �
<br /> (N)BALANCEr row `Jq/
<br /> _Y PROD A �� 3` � P"Mm POO
<br /> OEPARTME 'r USE I �
<br /> Application Accept �i _ Dete.... j L6-.......------- Area_ 1.2�}.... Emp } (M .................
<br /> Final Inspecti —. . .. - .. — Oate_..L.l� /Li_ SPECIAL PERMIT-Apprftby,
<br /> Character of Soil to epth of 3 Ft:____.____......_ Pit/Swnp Soil Character: H U
<br /> COMMENTS 1,�t'eI Q1tLr� 8AN I
<br /> PE Sc Received heck# — Amount Date Permit/ Invoice# Permit IDP
<br /> Code INFO B s Remitted.. _Service Re nest A
<br /> 4201 ONSITE.WASTEWATER TRTMNT SYSTEM PERMIT
<br /> 4/24112
<br />
|