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ONSITE WASTEWATER TREATMENT SYSTEM PEP-NUT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3—FL-STOCKTON CA 95202-(209)468,3420 <br /> NON-REFUNDABLE PERMIT / CALL(209}953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JO8 ADDRESS /1 / r.. Y7"t,)S� / _ CITY/ZIP Q Cl•P .��. <br /> CROSSSTREET CC //.cT T�_F _ APN C �I/-"' 12-0 7_,f PARCEL SIZE AXC -S <br /> OWNER NAME -�•�t-,l7 <br /> OWNER ADDRESS y/f AI.O_ CITY/STATE/ZIP d dfa j y r,4- <br /> CONTRACTOR <br /> JlCONTRACTOR - 5,aq Fl C PHONE <br /> CONTRACTOR ADDRESS CTTV/STATF/ZIP <br /> LICENSE ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE ���"'"'9���... <br /> WATER TABLE DEPTH: A GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION O REPAIR/ADDITION ❑ ENGINEERDFSIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL. OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: r <br /> NUMBER OF EMPLOY 'S• <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal 11107;COMPAR-MIENTS <br /> O CREASE TRAP TYPE/MFG CAPACITY gal #Of COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION IE^ PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE Or•PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS OF LINES LENGTH OF LINES }t <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE f[ <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> O SUMPS WIDTH ft LENGTH ft DEPTH tl <br /> DISTANCE To NEAREST WELL ft FOUNDATION III PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH a DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE tl I <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 /> MINIM M Z/4�HOUR ADVANCE.NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7597 <br /> SIGNED_, /�// I�C� TITLE Ile DATE <br /> 'dr- <br /> b11 (,U P <br /> w" <br /> _ d <br /> / / I <br /> r'.Y,•��T'f.E'4t 1• . . <br /> DEPART <br /> Application Accepted By Area z-- Employee lD# <br /> "'•F WillnspeetiDR�y - - ate - SPECIAb PERMi`f=Approved by-*• <br /> Ch -- <br /> CharacterotSoilto pt aracter: <br /> C MENTS 1 <br /> U/4 <br /> - <br /> PESC Received Chech#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INTO B Cash R it ed <br /> rvtce ucs <br /> 0o -43 <br /> at9 0 <br /> 42.01-00I <br /> 12(1102c2t, <br /> ONSITE WASTEWATER PERMIT <br />