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1 <br /> Al� ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95212-(209)4"-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPDRFS 1 EAR FROM DATE ISSUED. <br /> JOB ADDRESS a L��f vCCIITT/Y//ZIP °rAT C� <br /> CROSS STRIIET 1 –Y-xJ APN ��L.-J--L>L—/-i PARCELL SEM' 'T <br /> 1 PHONE <br /> OWNBRNAME <br /> OWNER ADDRP.SS C WyLf (+ CITYISTATFJZTP <br /> CONTRACTOR n!a 'I!ZS PHONE 42+ <br /> CONTRACrOlt ADDRDSS_P d 0 h . �Q _ L.'CTY/STATE/21P //1 a <br /> LICENSE ❑ C-42 Q C-36 OTHER_ NUMIIER LZI 19L3i EIWIRATION DATE 11 <br /> WATER TABLE DEPTH:_ ft GEOGRAPHICAL INFORMAn0N: Coordinates X _ Y <br /> ❑ PERC TEST # -- I BUILDING PERMIT# LAND USE APPLICATION!a <br /> TYPE OF WORK: 0 N)'W INSTALLATION Gr REPADVADDTnON O ENGINE in DESIGNED/ALTERNATIYE <br /> W' REPLACEMENT O DESTRUCTION <br /> INSTALLATION WILL SERVE: 0ESMENCE (3 COMna.RRcLkL Q OTHZ IA <br /> NUMBER OF LmNr.UNITS1R' 1 NUMBER OF B[DROONS' d _ NUMBli OF EMPLOYEES: VV�' <br /> Y SEPTIC TANK 1YPEIMFG_ P4-L- cAPACnY fa-ZTe 991 #OF COMPARTTaNTS� <br /> O GREASE TRAP 'IYFVMFG CAPACITY Bal #OF CoMFARTmENTS <br /> DISTANCE TO NEAREST: WELL 5.0+- ft FOUNDATION 10' _ ft PROPERTY UTNE W f R <br /> 13 LLIFT STATION SIS TYPE OF PUND+ 13 PKG n PLANT O SAND OD.SEPARATOR(ENCIgse)SYBTEIH) <br /> VI LEACH LINES O LEACHING CHAMBERS #OP LINES�_ LENGTH OF LINES <br /> DISTANCE TONEAREST WELL�I 1 ft FOUNDATION_ 0 R PROPERTY LINER <br /> O rLLIERBED WMTR ft LENGTH _R DEM R <br /> DISTANCE 7D NEAREST WELL ft FOUNDATION ft PROPERTY LAT: ft <br /> O MOUNDED WIDTH ft LENGTH R DEPM ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY 121m ft <br /> �3UMP5 WmTR :)L„ ft LENGTH_ If, / ft DEPTH 1 DI ft <br /> DISTANCE TO NEAREST WELL _ft FOUNDARON ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS W MTR ft LENGTH_ ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE, R <br /> 0 SEEPAGE PITS NUR%= WmIE ft DEPTH R <br /> DISTANCE TO NEAREST WDLL 11 '-0UCIDATION ft PROPERTY LINE R <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BL TONE IN ACCORDANCE WITH SAN JOAQUIN COLT <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> �....,,//MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(219)90-7697 6 <br /> SIGNED W� � TITLEIT I <br /> ��.A/'IcI"r`'�G�ar' DATE a <br /> J <br /> IL <br /> IF <br /> 8 <br /> a <br /> • <br /> I�PAxTM Ig 99E �Y <br /> AppnptlonAAxeptrA Ll�. y Arca <br /> FlzW IBspeetloD Dy tr O SPECIAL PER.'► F-Approved by <br /> Character�f Sritl w Dept►of Fc PAUMD Soil Character. <br /> COIS <br /> PGSC R-91ved ! Amant PervilH <br /> In-j-11 <br /> Code <br /> INFO B Remitted Date SEEftsM P -ft IDN <br /> om 0 2�1�► 2 <br /> 42-01 ONSITE WASTEWATER PERMIT <br /> 0 5 5 01200 7 <br />