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& e <br /> . -- -� ONSITE WASTEWATER TREATMENT SYSTEM PE <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3' FI.-STOCKTON CA 95202 -(209)468-3420 <br /> NON-RF'.ruNDABLE PERMIT CALL, 209 953-7697 FOR INSPECTIONS EXPIRE ..I YEAR FRONI DATE ISSUED <br /> JOB ADDRESS ' <br /> /f-! CITY/ZIP �/��LS/V -. �G✓ c�' J <br /> CROSS STREET :/T`//� _�_f APN e5 ,/ -;206'_ 49'7 PARCEEL SIZE <br /> OWNER NAME. /// ! /C�i l.-fJ�C� /7-�/C_ __ PHONE <br /> OWER ADIIRESS � �/)�`�•1�� CITI'/STATE/ZIP,�, 14Afee:r- �ry <br /> . IOR .! � PHONE ,4` - e=NTRAf -CONTRACCITY/STATE/ZIP. <br /> C <br /> y `�t <br /> V <br /> LICENSE C-42 El C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEP'rI+: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLAC.EMF.NT 13 DESTRUCTION <br /> INSTALLATION WILL SERVE: ESIDENCE ❑ CONINIERCIAL ❑ OTHER w <br /> NUNIBF.R OF LIAING UNII.S: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG CAPACITY' gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY -sawgal #OF COMPARTMENT \^\VV <br /> ❑ PKC TX PLANT DISTANCETO NEAREST: WELL /VC fl FOUNDATION S� ft PROPERTY LINE 7-30 <br /> ❑ LIFT STATION Slze TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ,LEACH LINES .&LEACHING CHANIBERS C�lC���+ #OF LINES_ may_ LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL ft FOUNDATION S"a ft PROPERTY LINE LQ ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH ft LENGTH III DEPTH ft <br /> DISTANCE.TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 11. <br /> ❑ SUMPS \\'IDTII ft LENGTH ft DEPTH ft <br /> DISTANCE TU NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS \\'IDTII B LENGTH it DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> E SEEPAGE PITS NUNIBER__WIDTH ti DEPTH ;2'5­ ft <br /> DISTANCE TO NEAREST WELL f fl FOUNDATION -� 11 PROPERTY LINE � 10 ft <br /> I HERLDY CERTIFY*THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> p11JiIN1Ud1 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED 1 /Y/=- -/1 __ DATE <br /> Z <br /> C_ <br /> r <br /> I IL <br /> + <br /> 3bX hf <br /> 1 LIC <br /> $oil I <br /> _LL I L 11 -1 m_i_iij__LL <br /> DF.PARI-HENT 'SE ONLY <br /> Application Accepted By_ <br /> ` — Date .7 2`r O-S Area Employee ID# •SSL�� `�I <br /> Final Inspection By Date jr—Jj ,r _ ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 FI: Pit/Sump Soil Character: <br /> COMMENTS A I.^ L�_V r-,F v'.9 _�) �/ <br /> G' g <br /> PE SC Received I:')lecld5, Amountate Permit! Invoice# Permit IDN <br /> Code INFD By, --CT%Ii Remitted Service Re uest# <br /> q2 737T-1-i <br /> ONSITE WASTEWATER PERMIT <br /> 41.0-nol <br />