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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> _—vA INUINU COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 ;I Aq <br /> IN-R DABLE PERMIT CALL(209)9R7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> f ' <br /> 3 ADDRESS ., C /'� CITY2IPIt i �� , y <br /> SSS STREET APN lam+� j ) �'� PARCEL SIZE Z7_• 0!i D <br /> -�1 0 <br /> NER NAME PHONE m <br /> N <br /> '2 <br /> NER <br /> y <br /> NER ADDRESS � L� , W`,L�L+ Q� ! <br /> CITY/STATE/ZIP <br /> VTRACTOR k �` p <br /> �'�Y.�-�(LI�S l(' .OP ��-x'.... PHONE ` <br /> VTRACTOR ADDRESS �*` ' �� CITY/STATE21P C - �� c <br /> ENSE ❑C-42 YC-36 OTHER NUMBER EXPIRATION DATE 11 <br /> m -la <br /> TER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# — Z LAND USE APPLICATION# N <br /> 3E OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION u, ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> ;TALLATION WILL SERVE: ❑ RESIDENCE X COMMERCIAL OT ER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: N BER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG pLc ' _ CAPACITY b gal #OF COMPARTMENTS <br /> GREAS 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 ❑ LE'4 ICH NG CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DIS ANCE TO N//EA��'EST V HELL �_ft 'FOU;DATION ft PROPERT`(LINE ft <br /> FILTER BED IDTH �Ly ft LENGTH / rle 1 ft DEPTH II <br /> DSTANCE TO NEAREST WELL a [f ft FOUt�II�ATION ft PROPERTY LINE ft <br /> MOUNDED WIDTH ft LENGTH ft DEPTH ft <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 ft <br /> :REBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> ST E LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI IMU 4 HO ADVANCE NOTICE REQUIRED FOR INSFyfv_�061 <br /> IONS-P EA CALL(209)953-7697 <br /> NE .v TITLE <br /> DATE kt) <br /> 771 <br /> V(35 <br /> q ; <br /> I <br /> i <br /> I _ o�Y. <br /> � 31 <br /> 1� $I <br /> rj! pit <br /> -------------- <br /> I A < <br />