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/ 00 <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 9$202-(209)466-3420 <br /> NON-REFUNDABLE PERMIT _CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS zmoo � � �c.0 CITY/7JP aLal <br /> V' <br /> CROSS STREET �7uiG,t)c 1 /7 APN ~/Y'���(/ /' PARCEL SIZE p <br /> OWNER NAME !t/ / i1�f PHONE jgJ <br /> OWNER ADDRESS <br /> CITY/STATE/ZIP <br /> CONTRACTOR GcsrJk/J� �ln�L� �r-�1/�� /- PHONE /Z7' <br /> CONTRACTORRADDRESS �7G��-j'S � ��/h Gl-JJS/� CRY/STATE21P 211/1 <br /> LICENSE 1*42 ,jC-36 OTHER NUMBER 1/590 S:-- EXPIRATIONDATE O7-'3/-/Z <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: G NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> J REPLACEMENT L OUT-OF-SERVICE SEPTIC SYSTEM n DESTRUCTION <br /> INSTALLATION WILL SERVE: $,RESIDENCE -I COMMERCIAL —(-I OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPLIMFG GX/Sh LVL CAPACITY FJK//O/S-4C gal #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPEJMFG 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 LEACHING CHAMBERS #OF LINES -L LENGTH OF LINES 4b" ft <br /> DISTANCE TO NEAREST WELL /nomOr ft FOUNDATION IV ft PROPERTY LINE ,FIO/ ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH fI <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE - ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DLPTH 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 _ fl FOUNDATION ft PROPERTY LINE ft <br /> 11 DISPOSAL PONDS WIDTH ft LENGTH --_ ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMULR 3 WIDTH :3 ft DEPTH 2g, ft <br /> DISTANCE TO NEAREST WELL _,2Q2�e —ft FCUNDATION ft PROPERTY LINE��DO f R <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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE- DATE - <br /> S I ----' -�— —� I, <br /> Ilk <br /> Co� I <br /> p i l <br /> C; :E TI <br /> Flv <br /> 1) r n644 <br /> Ili <br /> it <br /> G�N J Acih c 3:jjq <br /> f . <br /> i <br /> 11&1-7 DE AR MF <br /> LLJ <br /> EPARTMENS <br /> Application Accept Data Area 'EmployeeID#�` %4���� <br /> Final Inspection i Date 1 ! ❑ SPECIAL PERMIT•Approved by <br /> Character of Soil to D pth of 3 Ft: Pittump Soil Character: <br /> COMMENTS <br /> PE SCReceived Amount Date PermlU lnvotCo/ Permit IDN <br /> Code INFO B Ca emitted Service Re uest# <br /> I <br /> a2-01 ONSITC WASTEWATER TRTMNT SYSTEM PERMIT <br /> 9121110 <br />