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ONSITE Why FEWATER TREATMENT SN 'EM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER/1VE -3"°FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL(2019 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DD-ATE ISSUED JOB ADDRESS / �/ (J� 7 N, �,(�I(.Sy✓l CITY/ZIP��T-�G 1CT6,+ 9J CROSS STREET �.O N s�✓i T/ APN -7 — ��G�--sem PARCEL SIZE r }� p OWNER NAME /` PHONE eZ oq- y 7l-/fS�� m / " n OWNER ADDRESS �� !� Z!///1/y Q.4/(Z�- LkJ CITY/STATE/ZIP S�-b G�CTiryL �i's'2 0 p CONTRACTOR PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT DESTRUCTION 2- T-�-NC:�S INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION tt PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH tt DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft C ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH tt C DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 24 HOUR A WANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED ��S7-G9�laQ } 2v>0�2Tr�S/ TITLE ©��L DATE �SD 1 7 R EVt PRT E DEPARTMENT /-'-/C 'E ONLY c Z Application Accepted B Date � C Area Employee ID# J -19 Final Inspection By Date 3 SPECIAL PERMIT-Approved by Character of Soil to D th of 3 Ft: Pit/Sump Soil Character: COMMENTS ?Y7 r�.�'�tic i=) Z� � �L/��[/ `�7 G7� .��t�G�l,�r�L�7/>✓.C��17��G.�`�-cg�tl� 4�-r��iC, PE SC Received C eck#/ Amount Permit/ Code INFO By Cash Remitted Date Service Request# Invoice# Permit ID# 42- at 07s //o3 rov,v-0 3100:7 5 Ll f ?t3Lf� ' C/ �LF� � ltt��/ � gGL��!'L� S ` 'J� �IVSR� STE ATElYE�JW 12/22/2003