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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENYI RON\I EN I Al.IIF%i.FH DI-PARTNI ENT 304 E WEBER A%E..3"Ft..STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDAB E rERNIIT (-ALI. 209)9.A'; -7697 FOR INSPL('I IONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/LIP..J 1\J <br /> CROSS STREET ( JI APN .� :A62 <br /> RCELSILE <br /> CJ <br /> x <br /> ren , <br /> OWNEN ADDRESS2 — 1F./w' CIIY/ti TATE/LIK ,fir _ <br /> CONTRACTOR "I,_ _- 36145 tN� PIIONI. OZ- <br /> jj <br /> CONTRA(-TOR ADDRES. W-Sn ('11)-/STAT/JLI <br /> LICENSE C-42 ❑C-36 OTHER NHMBEN E%PIRATIM DATE <br /> MATER TABLE.DEPTH: It GEOGRAPHICAL INFORNIATION: Coordinates X Y' <br /> ❑ PERC TEST p BUILDING PERMIT/t LAND USE APPLICATION fY _ <br /> TYPE:OF AA OR K: O NEW INSTALLAIHI% REPAIR/ADDITION ❑ ENGINEER DF.SIGNED/AI.TERNATI\'E <br /> ❑ REPLACEMENT ❑ DE.srRL(-I'ION <br /> INSTALLATION MILL SERVE: RESIDENCE CO%IvtFRrul. ❑ OTRE. <br /> NUMBER OF LI\TNG UNITS: NL MHFR OF BEDROOMS: \UMBER OF ENIPLOl E.ES: <br /> ❑ SEPTIC'TANK TN PE%M IYi CAPACITI- gal 4()F COMPARTNIFNTS <br /> ❑ GREASE TRAP TYPr,'MFO C.APACIII gal #OF COMPARTMEN IS <br /> ❑ PKC TX PLANT DISfAN('E.TO NF.ARFST: WELL _ It FOLN'DArIUN ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE T%PEOFPUSIP�J QG ElSAND OIL SEPARATOR(EN(LOSEDSISTENI) <br /> LEACH LINES )( LEACHING CHANIBERSEQ6Z 3G k OF LINFS LENGTH OF LINES R <br /> DISTANCE TO NEAREST WELL _ ft FOUNDATION It PROPERTY LINE <br /> ❑ FILTER BED MInTR ft LENGTH It DEPTH ft I` ' <br /> DISTANCETONEAREST WELT -- R FOUNDATION _R PROPERLY LINE. It <br /> ❑ MOUNDED N'IDTH It LENGTH fl DEPTH It <br /> DISTANCE TO NEAREST WFLI. _It FOUNDATION R PROPERTY LINE <br /> XSUMPS WIDTH — l,E."'r i I�}— R DEPTH ft <br /> DISTANCETO NEAREST WELL 1 It FOUNDATION Q Fl PROPERTY LINE It <br /> ❑ DISPOSAL PONDS M"IDTH Il LENGIH_ ft DEPTH —ft <br /> DISTANCE TO NEAREST WLLL R FOUNDATION A PROPERTY LINT: ft 1`J <br /> El SEEPAGE PITS NI MBER WIDTH It DEPTII ft <br /> DISTAN('ETO NEAREST WF'1l ft FOLNDATION It PROPLRTYI.INE (t <br /> I FIERF.BA CERTIF\THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK Will.BE DONE IN ACCORDANCE WITH SAN JOAQL IN COt'NTV <br /> (/�� ORDINANCES,STATE LAW'SAND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> �1-1��a11gNIM \ \ \C NOIICE RFQI'IHED I-ORE E: TIf�NS-Pl. L COvI yS3-7Ny' <br /> S I G N E !1` TI1'1. DATE <br /> 00 <br /> 0 <br /> I Woe <br /> P Ty <br /> .Application Accepted t, Date Area Employee IDN <br /> Final Inspection By _ - -sem Date _ ❑ SPECIAL PERMIT-Appmved by /I Y <br /> Character of Soil to Depth of 3 Ft: 1 ' Pit/Sump Soil Character: <br /> COMMENTS 1),y _g t i�s+>�1 yl_ l�C ,L�-j11p4.1 f2Q "U <br /> - `� <br /> PE SC eceived Chec- Arrmun Dale Permit/ Invoice p Permit IDN <br /> Code INFO B aCsh Remitted Service Request N <br /> S O <br /> 42-02.001 ONSITF WAST'LN-AILS PERMIT <br /> 1222'2007 <br />