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� -c <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 800 E MAIN STREET - STOCKTON CA 85202 _ (208) 488-3420 <br />JOB ADDRESS <br />CROSS STREET.. <br />OWNER NAME II -A <br />OWNER ADDRESS <br />P)EJRMIT20 <br />��,CALL ( 9) 953-76.97 FOR INSPECTIONS EXPIRES 1 YEAR <br />)11 G., tT f"1 .. CITYlZ1P <br />_, CITYISTATEOP <br />ot-101 _. <br />CONTRACTOR ADDRESS" X -4,L,) t'W%XY14%31r,2 ..±Cj--AL.7 tIITIJIA;wJ <br />LICENSE QC -42 xC-3S OTHER NUNSER'E3k�EXPIRATION DATE <br />PARCEL SIZE 'u., 90 <br />PHONE , — "J_..JC�I f <br />rAI rn 7i <br />WATER TABLE DEPTH: <br />R GEOGRAPHICAL INFORMATION: Coordinates X Y <br />`�3j BUILDING PERMIT # .. LAND USE APPLICATION # <br />Cl FERC TEST # <br />TYPE OP WORK: <br />DESNE0lAL7ERNATIVE <br />NM INSTALLATION ... REPAIRIADDiTWN E, EN0iNEER K4 <br />DISTANCE TO NEAREST <br />REPLACEMENT i:' OUT -OF -SERVICE SEPTIC SYSTEM CI DESTRUCTION <br />.. <br />INSTALLATION WILL SERVE: <br />0 RESIDENCE -- COMMERCIAL 0 OTHER <br />NvMEER OF LIVING <br />UNITS: NUMBER OF BEDROOMS:'�.yry NuMEER OP EMPLOYEES: <br />CI SEPTIC TANK <br />TYPENFG i+t` CAPACITY ]c 4-> gal # OF COMPARTMENTS <br />O GREASE TRAP <br />TYPE/MFG CAPACITY gat # OF COMPARTMENTS <br />It <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE IT <br />• UFT STATION <br />SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />X LEACHING CHAMBERS _ III OF LINES <br />PermitlDX <br />LENGTH OF LINES <br />it <br />DISTANCE TO NEAREST <br />WEL %t <br />'; FOUNDATION <br />ft PROPERTY LINE <br />It <br />L7 FILTER BED <br />WIDTH <br />it LENGTH <br />It <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />O MOUNDED <br />W40TH <br />ft LENGTH <br />It <br />DEPTH <br />It <br />DISTANCE TO NEAREST <br />vyELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />it <br />d SUMPS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />it <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />It PROPERTY LINE <br />It <br />C3 DISPOSAL PONDS WIDTH <br />It LENGTH <br />ft <br />DEPTH <br />It <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />It PROPERTY LINE <br />It <br />SEEPAGE PITS <br />NOMaER <br />WIDTH <br />ft DEPTH <br />it <br />DISTANCE TO NEAREST <br />WELL _.._. <br />it FOUNDATION _._....... <br />iI PROPERTY LINE <br />ft <br />1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN J0AQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />TITLE <br />DATE <br />T Y <br />Application Accep-)ate Area Employee IDI# <br />Final Inspection y� a ' Date I SPECIAL PERMIT - Approved by <br />Character of Soil to of 3 Ft: Pi Sump Soli Character: <br />COMMENTS <br />��a�-.--1.�_.iL.Z'�77" ��./� `~�yP ��f ��� 1 i % � .S)��� �4`l".i Arf «f. t �':��'i ✓,El- /�f�P,-L.:��/Ca. . <br />/Y.i3TGa+i�rt/_�Ys�ia*Jry�t� <br />PE SC Received Chet:k/t/ Amo t <br />i Code INFO By Cash Remitted <br />Date Permit/ Invoice# <br />Service_Renest # <br />PermitlDX <br />��'�j <br />3 <br />fj <br />i <br />..... <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />812V10 <br />Ll <br />