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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAWN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 4868 E.HAZELTON AVENUE-STOCKTON OA 95206-{2H$I48$-3$20 <br /> NoN-REFuNDASLE PERMIT CAL f209FOR INSPECT ONS EXPIRES 1 YEAR FROM DATE ISSUED � <br /> Joe ADDRESS_.', -�i '3/ ,liL _ crcvtzlPfed7>_a,-. ,X!y✓/rl" frtc7lr __ -y <br /> APN C V �t'S PARCEL SIZE I � r <br /> GROSS STREET, r 5Q <br /> PHONE <br /> OWNERNAASE- <br /> A jCITYISTATEIZIP <br /> OWNER <br /> PHONE _CONTRAC <br /> lL0 �✓/ <br /> CONTRACTOR ADDRESS Flo. T.:)CJ.�.' 7Y�"� CITYISTATEJZH',,,�-�'✓-�- s"�'"" 7�• � <br /> LICENSE "::;C-42 L! C-36 OTHER NLwBER:5.?3 03,;_E:PiRAnON DATE <br /> WATER TABLE DEPTH: ft GECGRAPHILAL INFORMATION: Coordinates X Y 1 <br /> { <br /> PERC TEST # BUILDING PERMIT# A LAND USE APPLICATION# <br /> TYPE OF WORK: NEW MIALL.ATFON REPAIRIADDITiON ENGINEER DESIGNED fALTERNATHVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM ._ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL ,++yy OTHER <br /> I NUMBER OF LIVING UNITS I NUMBER OF BEDROOMS. 'l✓ NUMBEROF EMPLOYEES: _... <br /> %-SEPTiC TANK TYPFJMFG C"f lr CAPACITY gal #of COWARTMENTS -- <br /> 0 GREASE TRAP TfPETMFG CAPACITY 9ai #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL/.GLS' h FOUNDATION h PROPERTY LANE 'z✓' it <br /> C3 LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEW <br /> LEACH LINES LEACHING CHAMBERS-9CCk&i� #OF LNES— /_ LENGTH OF LINES �y A it <br /> DISTANCE TO NEAREST WELLh?J0 R FOUNDATION `�'�`L� It PROPERTY UNE tt <br /> 0 FILTER BED WIDTH ft LENGTH ft. DEPTH R <br /> DISTANCE TO NEAREST WELLh FOUNDATION h PROPERTY LINE h <br /> 0 MOUNDED MOTH ft LENGTH It DEPTH py� ft <br /> DISTANCE TO NEAREST WELL h FOUNOATI <br /> ON h PROPERTY LINE ""mewft <br /> Lt SUMPS WIDTH ft LENGTH fi DEPTH RECESMD <br /> DISTANCE TO NEAREST 'JELL It FOUNDATION R PROPERTY LINE_A�,I�I& '�'1,,,.,S,pth <br /> 0 DISPOSAL PONDS WIDTH ft LENGTH h DEPTH CCS�I TT( SIA J ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION h PROPERTY LN£'N JOAQ"2I,11N <br /> Ll SEEPAGE PITS NUMBER WIDTH h DEPT " <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE <br /> I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOADUN COUNTY, <br /> MINIMUM 24 HOUR AQVAhC NO710E REQUIRED FOR iNSPEC7IONS-PLEASE CALL 953-7697 <br /> SIGNED TLTLE e576W--'.- , DATE �—?—/7 <br /> 3 � <br /> 1 <br /> T <br /> 42„ <br /> 1 � <br /> DEPA R7AIEN7..USE. LY <br /> ApOicationAcca Date 1 Area �LEmployeeiU# fS'iasm <br /> Final Inspe . y <br /> Date 4' SPECIAL PERMIT-Approved oY <br /> Character of Soil to tit of 3 Ft: Pit/3Ump Sail Character: <br /> COMMENTS 3 � <br /> PE SCReceived Choc Amount Permit/ Invoice Permit 00 <br /> Code 3 lniFo B Remitted Date gervice Request# <br /> i! I 3n= <br /> 4-07 ONSrrE WASTEWATER TRTMNT SYSTEM.PERMIT <br /> i72N72 <br />