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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202.(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(2091,953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 2-1 TO Z 3- SA f JTA FE AD. �t q CITYIZIP ES GPS LOIJ 45;32-0 <br /> a <br /> CROSS STREET 1�SGlbNE-1Z APN 2-T ! I 1V PARCELSIZE'e� <br /> OWNER NAME Aocv! PHONE 345 5 - 09VO <br /> OWNER ADDRESS S Pswi CrrY/STATE/Zip <br /> CONTRACTOR l-IVC 0A'y- GtD�N'J12a1�f�+rlE�v"f1`�l_ PHONE 319 !p <br /> `03-1 <br /> "'( <br /> CONTRACTOR ADDRESS o 1 W . Qr�py5_ <br /> — ' CITY/STATE1ZIP LOD! CA -p <br /> /S2-�-D <br /> LICENSE OC-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: C NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> C REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LMNG UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ 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 ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 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 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 /> MINIMU UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE C6'-jSuL-TI`�NT DATEIV <br /> Ay <br /> t 209 <br /> b q <br /> OUN� <br /> Tq� <br /> TMeNT <br /> ff <br /> DEPARTMENT,VSE ONLY <br /> Application Accepted By f Date AreaEmployee ID#2� <br /> Y <br /> Final Inspection By Date ❑ SP 4PERI"�Approved by <br /> Character of Soil to De th of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS /Y./ <br /> PE SC Received hec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By ash Remitted I Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />