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ggog3 LeAwi Yl <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN CO TY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET - STOCKTON CA 95202 - (209) 468-3420 <br />NON-REFUNDA E PERMIT CALL (20 ) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS '�- 4 tl / T et [ CITY/ZIP <br />CROSS STREET / • �� -- Glut A(/PN PARCEL SIZE 1/0 <br />OWNER NAME �// /c! \ / • /' 1r7"' ��tY/" PHONE/ <br />OWNER ADDRESS "C /r'�I `� CITY/STATE/ZIP / " "� j ,/ �J �if ✓��� <br />CONTRACTOR PHONE <br />CONTRACTOR ADDRESS �C �'�/ J ry / CITY/STATE/ZIP L'reWc o"C, <br />LICENSE ❑ C42 ❑ C-36 OTHER NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: O NEW INSTALLATION ❑ REPAIR/ADDITIO ❑ ENGINEER DESIGNED /ALTERNATIVE <br />❑ REPLACEMENT DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NMV*r6R OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG CAPACITY gal J <br />LlGREASE TRAP TYPE/MFG CAPACITY 31�tjj' <br />OMPA-144 <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR CLOSED SYSTEM) <br />❑ LEACH LINES <br />❑ LEACHING CHAMBERS <br />Check# <br />Cash <br /># OF LINES <br />In �c <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />ft PROPERTY LINE <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft <br />ft <br />ft PROPERTY LINE <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />ft <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />❑ DISPOSAL PONDS <br />WIDTH <br />ft LENGTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />a <br />0 <br />O <br />N <br />LENGTH OF LINES <br />ft <br />Check# <br />Cash <br />Amount Date Permit/ <br />Remitted Service Re uest # <br />In �c <br />N <br />ft PROPERTY LINE <br />ft <br />yz2 <br />DEPTH <br />ft <br />I �0 123 �_�� <br />D <br />ft PROPERTY LINE <br />ft <br />DEPTH <br />ft <br />ft PROPERTY LINE <br />ft <br />DEPTH <br />ft <br />ft PROPERTY LINE <br />ft <br />DEPTH <br />ft <br />ft PROPERTY LINE <br />ft <br />DEPTH <br />ft <br />ft PROPERTY LINE <br />ft <br />1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />i1. .nom .r - . -- <br />Final Inspection By Date Iu ')PEUTAL YEKMI f - Approveo by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS -6—, hx- i).e� ol/ t � --/,) 10 A47" .S)C�R <br />PE <br />Code <br />SC Received <br />INFO B <br />Check# <br />Cash <br />Amount Date Permit/ <br />Remitted Service Re uest # <br />In �c <br />r t ID# <br />yz2 <br />0 <br />oat <br />I �0 123 �_�� <br />D <br />42-01 ONSITE WASTEWATER PERMIT <br />05/30/2007 <br />