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4 4 10WONSITEAS� <br /> AT TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95206-(209)468-3420 <br /> NON-REFUNDABLE PER`JMiT CALL 209 953-7697 FOR INSPECTIONS XPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS <br /> CROSS STREET �,Cl/� �� APN O� PARCEL SIZE <br /> Z 3 Y <br /> _ !!�� C <br /> OWNER NAME�L�! 2c C Syq, 3�1 7 <br /> PHONE !, <br /> OWNERADDRESS jilrnff CITV/STATE/ZiP <br /> CONTRACTOR '�'7 J UI Z, �7'C�� ,o PHONE <br /> CONTRACTOR ADDRESS7W/1 Z2i9—CITWSTATEIZIP <br /> LICENSE :f/L.L1-02 I_' C-36 OTTERJ NUMBER 7 EXPIRATION DATE <br /> WATER TABLE DEPTH: q Iii ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ' PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLAnON 1k, REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-0F-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> FINS�TALLATIONLL SERVE: tom' RESIDENCE F1 COMMERCIAL _ OTHER <br /> VING UNITS:- C�I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> L3IM <br /> SEPTICTANK TYPEFG Fel/i,4CAPACITY gel #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY <br /> gel #OF COfu1PARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 13 LIFT STATION SIZE TY PE OF PUMP _❑ PKGTXPLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> a� LEACH LINES LEACHING CHAMBERS /0 #OF LINES LENGTH OF LINES Z�♦2 A fi <br /> DISTANCE TO NEAREST WELL I Ah eft FOUNDATION I Q, ft PROPERTY LINE / If <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WE,I. R FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH if <br /> DISTANCE TO NEAREST WELL R+�FOUNDATION fi PROPERTY LINE ft <br /> SUMPS WIDTH f R LEN,TH lO'J it DEPTH <br /> DISTANCE TO NEAREST WELL ` Y ft FOUNDATION_ /{�• it PROPERTY UNE .SV� R <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> 1 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 /> MINIMUM48 H0UAAQVAN$2FNOTICE ! FOR!N P T y g g -769 <br /> SIGNED «� <br /> TITLE !� ._ -_ DATE- LTi r+d <br /> v <br /> .IJ <br /> 1144�4rjj All djr1jjPAjj-441- <br /> �E p <br /> RFcYMFN <br /> Fid r <br /> 3 �00 <br /> ` I A I ✓ q QVC c 1 <br /> �Fpq�A, �NTY <br /> ' I MFtir <br /> DEPARTMENTV N I <br /> Application Accepted By, Date C 'JL Area �7 �r , Employee icv DA <br /> {t^ <br /> Final lDspectien By I ` Dates PECIAL PERMIT-Approved by <br /> Character of Soil tqq O�+tth of 3 Ft: Pwsump Son fatter: <br /> COMMENTS X r1l n /P4'son r ,�pctilr, �/.cc�fl�n oFIc1nU� nefm�t 1583 offs Pncoo.nkfeel <br /> sc,nr/c,f 17 reef. No lAra6, IInP Lrjj b �+I�crd �,►,e/ �cr�{e� 6]uckt�o r� nc� ,clwcf�y/ <br /> Or-StrUCfuve, LeocV+ lints" avlc.�dYs�c,sq� 4Tele/s imvsf be ,v►c,iy ><t.;InedinonoPr►7 c1tL'cf y4c�n-ot t,lrt�r.tre <br /> PE SC Received Ch*CW Amount Permit/ htvoket Permit mil <br /> Code INFO B sq Cash Remitted a Service Re uest t <br /> `Id)o 011- <br /> i <br /> I �� o,�'L �j/JJL.� I <br /> 42-01 l/^'_ v� r �- "`� -- i ON ITE WASTEWATERXTI2TMNT SY4rEM PERMIT <br /> 0.14;18 l/'E�i✓/ J� <br />