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f?3a <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQVjji Cor NTY ENVIRONMENTAL HEALTH DEPARTMENT 600 F.MAIN STREET-STOCKTON CA 95202-(209)4653420 <br /> NON-REFUfvDAB E CALL 9 953-'7697 OR INSPECTIONS EXPIRES 1 ATETSSUED <br /> y <br /> JOB ADDRESS I CITY/ZIP <br /> CROSS STREETWAAR�5 <br /> v AP N �L0/^ PARCEL SIZEOT 'y tl <br /> x <br /> OWNER NAME <br /> PHONE <br /> OWNER ADDRESr♦!q`� �'�{^ CITYISTA (ZIPCONTRACTOR _�`.](��(^J O N y PHONE <br /> CONTBACTOR ADDRESS+CM �/ (t Wk <br /> C.11STA7EIZIP +1 <br /> LICENSE )i C-42 U C36 OTHER NU.'�fBER� t 1 EXPIRATION DATE <br /> WATER TABLE DEPTH:, ft GEOGRAPHICALINFORMATION: COordinatCS X Y <br /> O PERC TEST # BUILDING PERMIT# LAND USE APPLICATION <br /> TYPE OF WORK: U NEW[WrALLATION 13 REPAIR(ADDITION 0E GINEQR DESIGNED(ALTERNATIVE <br /> i] REPLACEMEv 1k DEVI'RUCTION <br /> INSTALLATION WILL SERVE: SIDENCE O COM.MER0Q OTHER <br /> NU.MBEROF LIVING uNTTS: NUMBER OF BEDROOMS: NV..%MR OF EMPLOYEES: <br /> SEPTIC TANK 'IVPP/MFG I CAPACITY (beaSzi #OFCOMPARTMFNTS <br /> D GREASE TRAP TYPWMFG _ CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION _ ft PROPERTY LINE ft <br /> O LIFT STATION SIZE TYPE OF POMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYS7EM) <br /> 0 LEACH LINES 0 LEACHING CHAMBERS ii OF L NES LLNGmi OF UNES ft <br /> DISTANCE TO NEAREST WELL ft FOCNDATION__ ft PROPERTY LINE__ ft <br /> 0 FILTER BED WmtH, ­21 LENGTH__.. R DEPTH ft <br /> DISTANCE TO NEAREST WELL_ ft FOUNDATION ft PROPERTY LINE ft <br /> O MOUNDED Wmru .....—ft LENGTHft DEPTH. ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O SUMPS WMTH ft LENGTH_ ft DEPTH ft <br /> DISTANCE TO NEAREST WELL _It FOUNDATION R PROPERTY LIVE R <br /> O DISPOSAL PONDS WmrH �ft LENGTH-- ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOLNGATION ft PROPERTY LINE ft <br /> 0 SEEPAGE PITS NUMBER WmTH _R DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNMATION R PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORD NANCM STATE LAWS AND RULES AND RMULATIONS OF SAN JOAQUIN COUNTY. <br /> r'\^'1J N4IN�(�J17DNS �L(��.���y..��tNV ICEREQUIREDFORIN P NS- L L(209)953.7697 <br /> SIGNEDGM �! W V t TITLE DATE' <br /> i <br /> I <br /> i <br /> Aid- 11 <br /> O c15tn T-1 <br /> 0 LO <br /> v 19 <br /> M <br /> R <br /> Dlt ARTM£N SE O J <br /> AppliptioR Acce-p/tFd) _ ate Area F_crlployeC iD# <br /> Final Inspection l �C Date_ I _ 0 SPECIAL PERMIT-Approved by <br /> Character of Stdl to of 3 Ft: tlSump Soil Chaneter: <br /> COMMEmrs a,,IZl��G <br /> ii PE SC Recdved h.W Amount ermiv <br /> Code INFO By Cash Remitted Date Service Request# voke# Permit iD# <br /> c" 1 14 4 1,W. 1136 g A-o O <br /> 42-01 ONSITE WASTEWATER PERMIT <br /> osnmzoo� <br />