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ONSITE WASTEWATER 1-1117AUAFNT SYSTEM PERMIT Pf
<br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HA7ELTON AVF:NIIF-STOCKTON CA 95206-(209)468-3420
<br /> NON-REFUNDABLE PERMIT CALL ?0! 953-7697f*OR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED
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<br /> JOB ADDRESS_.�. G »� �/ .� _._..._.__......._.._..........CITYfZtP
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<br /> GROSS STREET .1 7- jU—.._--_.._,____ -._..-.,-.__..APIN 10/7-i/4_- O...............-.---_..._.....PARCEL BILE
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<br /> OWNER NAME-�;//—/ ,.,,,--'f�-' �
<br /> 1 V �__.__..._.......,_._...__..,.__..._....._.___._..__....�....PMOHE_d'.'r,,,_L- _ �g---31.�.C..
<br /> OWNER AODRESS13�bk�--_��� 0-----i __.__._.._,,,,,,,._,,,;ATVISTATE/ZIP .5-A c?s717--
<br /> CONTRACTOR PHONE Q .I=
<br /> CONIRACTOR ADORES9 y� � j.�l� �L, ., ,_...._...._...._._._�..:.._._......._ CRY/STATERIP
<br /> LICENSE 4' 'C-42 OC)" OTHER_ NUMBER _EXPIRATION DATE.../----7-
<br /> WATER
<br /> ATE.,/-2WATER TABLE DEPTH: ft GEOBBAPHICAL INFORMATIEIN: Coordinates X.-.,.. Y_- ......
<br /> 0 PERC TEST M . SUILD(NC PERh117 N__..... _..._..-._ _LAND USE APPLICATION# ......_............
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<br /> TYPE OF WOK:_ .. NEW INSTALLATMN 7-, nEPAIRIAWF(tON ENGINEER DESIGNED/ALTERNATNE
<br /> '1 REPLACEMENT ..._�.,.�_..,_ OUT-OF-SERVICESEPIICSYSUM DESTRu0TID14
<br /> INSTALLATION WILL SERVE: X, RESWENCE COMMERCIAL
<br /> NUMBER OF LIVING UNITS: . NUMBER OD BEOFlJi'HdS:.._....L..!-_,.,__._,„_.,.........,,.._NUMBER OF EMPLOYEES:._..--_.-..
<br /> ❑ SEPTIC TANK TYPE7MFG __ _ CAPACrTY _-.., gal NOF COMPARTMENTS
<br /> ❑ GREASE TRAP TYPEIMFG .-._ � _- CAPACITY _..__ gel A OF COMPARTMENTS-—
<br /> DwANcE
<br /> OMPARTMENTS _,_,-
<br /> DL9TANCE TO NEAREST: WELL_ _ R FMNOATMN_-,__.. It PROPERTYLINE -.____-___._-ft
<br /> ❑ LIFT STATION SIZE TYPE OF PUMP-_-,___-_,.__0 PKGTX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM)
<br /> L LEACH LINES LEACHING CHAMBERS, NOF LV*S-/�/ ,_.., LENGTH OF LINES �ft
<br /> DISTANCE TO NEAREST WELL._Ln;,�'-��__.,_, It - FOLINDATION,.,r,GG�_f..It PROPERTY LINE N
<br /> O FILTER BED WIDTH.--.....__...... ....... --ft LENGTH. .._...._._..._._..__,_ _it Ot?i^iH
<br /> DISTANCE TO NEAREST WELL_._ It FOUNDATION ft PROPERTY LINE ft
<br /> ❑ MOUNDED WIDTH_.___..__...._..._..__.._It LENGTH
<br /> . DISTANCE TO NFAAREST WILL.--9, FOUNDATION__. . tt PROPERTY}.INE_...._-___-.,,.-,.,.,,.,,,._ft
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<br /> SUMPS WIDTH^_ ...._.._....____it LENGTyHft L)FPTHR
<br /> ` DISTANCE TO NEAREST WELL /L!,Z it FOLMA'TION_-., ,,,,.....R PROPERTY LINE
<br /> n DISPOSAL PONDS WIDTH ._...._,_.....-....___,...... ..ft LEWTH_ _.�. ____-_-!t DePTH it
<br /> DISTANCE TO NEAREST WELL---.-..._-._.._.. it FOLMATYM!__._..,„_.....„.-ft PROPERTY LINE It
<br /> ❑ SEEPAGE PITS NUMBER_.__ WNDTN_,-__.-.______.._..--...—_-..-__ft DEPTH_.._.______,_ _ it
<br /> DISTANCE TO NEAREST WELL--.it FOUNDATION.. _ft PROPERTY LINE it
<br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN
<br /> JOAOUIN COUNTY ORDINANCES,STATE LAWS, AND RULES AND REGULATIONS, I ALSO CERTIFY THAT MY REOUIRED LICENSE IS
<br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL
<br /> WORKERS COMPENSATION LAWS.
<br /> GE N�,T1GE R•Fa,�gf.-,�;�f�.1N5P��'10NS-P(,�A��,•�ALL 12t1Q)_�3 7697
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<br /> 81GNED •�/ -�ry.:✓--_._,.,..�..._..............-,.. TITL[.G�._.._..,......_.-_.._....v...�..._ DATE....C._
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<br /> Application Accepted B _. _ _ Dale. �.. ......._.. Area W .q.._ Employee IDN..
<br /> Final Intepectlon By_ �� C.I SPECIAL PERMIT.;Are
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<br /> Character of Soil to Depth of 3 Pt._.C`°� -.._ ._.. _...... Pivsump Soil Character: ..............g
<br /> COMMENTS_�l7� f1Q [ail_.`
<br /> PE SC Received eeT Amount Permi7 Invoice M Permh IDM
<br /> Cod IflPo _ c Rem ed Scrvics Rsgw�t M _„ _
<br /> 42.01 ONSITE WASMWATF.R TRTMNT SYSTEM PFRMrT
<br /> 515117
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