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i <br /> ONSIT- ASTEWATER TREATMENT SYST PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENT, ALTH DEPARTMENT 304 E WEBER A AO FL-STOCKTON CA 95202 - (209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DA-TE ISSUED <br /> 308 ADDRESS [ C CITYIZIP t c' <br /> CROSS STREET l+"�XAPN 66 I I/,I✓IPr PARCELSIZE 9. 2 �. y <br /> LJ <br /> u� / 1 d <br /> OWNER NAME , 5 I'�I aanC,(✓+ 0 <br /> WNER ADDRESS I TY/STwTE/'LIP <br /> CONTRACTOR PHONE <br /> G <br /> CONTRACTOR ADDRESS C YISTATE/ZIP ..� <br /> LICENSE ❑C-42 ❑C-36 OTHER NU ER EXPIRATION DATE <br /> WATER TABLE DEPTH:_ ft GEOGRAPHICAL I NPORMAT Coordinates X V- <br /> 0 <br /> _❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITIN LJF�YGINEER DESIGNED(^ `ALT,B R(�ATIVE <br /> T� vTJ-Zi�Ld <br /> ❑ REPLACEMENT ,kDESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIA ❑ OTIIER_ <br /> NUMBER OF LIVING UNITS:_ NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG_ CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS_ 7w <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE R Q <br /> ❑ LIFT STATION Slu TYPE OF PUMP ❑ SAND 011.SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 0 LEACHING CHAMBERS #OF LINES LENGTH OFDNES tl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 11 PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH R LENGTH i[ DEPTH ft <br /> DISTANCE TO NEAREST WELL_ ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH _ft DEPTH 11 <br /> DISTANCE TO NEAREST WELL R FOUNDATION_ fl PROPERTY LINE fl <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION_ fl PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH t1 <br /> DISTANCE TO NEAREST WELL _ ft FOUNDATION it PROPERTY LINE R <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE 11 <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATION'S OF SAN JOAQUIN COUNTY. <br /> MINIM L' OUR VAMC' CE REQUIRED FOR lNSPE T O '-PLEASE C I 993.7697 <br /> r ��v l3 <br /> IGNED _ TITLE 4 UA'I <br /> r <br /> t. <br /> V" <br /> S <br /> —71 <br /> -57 <br /> S O <br /> T � <br /> DEPARTMENT,USE 9'%LV <br /> Application Accepted By kV V40,� _ Date11310-3 Area �� Employee ID#_ J �� <br /> Final Inspect bn 84�- Date /Z"JZ 3 11SPECIAL PERMIT-Approved by <br /> Character of Soil to De of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount P it! <br /> Code INFO B ash Remitted <br /> Date ervl Invoice# Permit lU# <br /> 49-1 <br /> I <br />