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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS J��� / CITY/ZIP �il)'y/}Pq-c )rLA <br /> CROSS STREET ��� / ��� A P N �/G? - r O`/ L PARCEL SIZE 0' Q '" <br /> OWNER NAME Che' 7/4'-7 e-1 �/ "C<<' Z PHONE 20% 4 AU, R <br /> OWNER ADDRESS PLS [J 9 / CITY/STATE/Z <br /> IP <br /> J —1-7C` t- 7 C'4 `?5-Z3(, <br /> CONTRACTOR? �G ? 'LG. PHONEJ/J� /� //�� <br /> CONTRACTOR ADDRESS �U7,,t„ (��� 2 CITY/STATE/ZIP J JT 6 7�- V'514 ga�� <br /> LICENSE ❑ C-42 ❑DC-36 OTHER NUMBER 6 EXPIRATION DATE Asem_} ) '!2::1= <br /> WATER TABLE DEPTH: �V ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION i ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: FSIDENCE ❑ COMMERCIAL ❑ OTHER <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 <br /> DISTANCE To NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES /LEACHING CHAMBERS' /i <br />