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ONSITE WASTEWATER TREATMENT SYSTEM PERNUT SAN JOAQUIN COUNTY E4IRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE - 310 FL - STOCKTON CA 95202 - (209) 468-3420 NON-REFUNDAI.L� PERMIT CALL (2M 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED LICENSE C-42 ❑ C-36 OTHER NUMBER EXPIRATION DATE WATERTABLEDEPm: ft GEOGRAPHICALINFORMATION: Coordinates X Y ❑ PERC TEST #BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLAnON ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: -% SEPTIC TANK TYPE/MFG-V-- ❑ GREASE TRAP TYPFSMPG �IWCAPACITY 2-400 gal #OFCOMPARTMENTS CAPACITY, gal #OFCOMPARTMENTS ❑ JonADDRESS DLSTANCE TO NEAREST: WELL�� it F904DATION60 ft PROPERTY LINE 10 ft X LIFT STATION t 1 SIZE tl TYPE OP PU�. 1MP Q SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES V LEACHING CIIAMBE# -FL-LENGTH OF LINES , U OWNER ADDRESS X 56540? �\ L�50 DISTANCE TO NEAREST WELL i fl FOUNDATION tJ ft PROPERTY LINE �J�J ft DN M -r -A T7,53-56 ❑ FILTER BED LIQ i i . _ . _._ • C- SII LICENSE C-42 ❑ C-36 OTHER NUMBER EXPIRATION DATE WATERTABLEDEPm: ft GEOGRAPHICALINFORMATION: Coordinates X Y ❑ PERC TEST #BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLAnON ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: -% SEPTIC TANK TYPE/MFG-V-- ❑ GREASE TRAP TYPFSMPG �IWCAPACITY 2-400 gal #OFCOMPARTMENTS CAPACITY, gal #OFCOMPARTMENTS ❑ PKC TX PLANT DLSTANCE TO NEAREST: WELL�� it F904DATION60 ft PROPERTY LINE 10 ft X LIFT STATION t 1 SIZE tl TYPE OP PU�. 1MP Q SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES V LEACHING CIIAMBE# -FL-LENGTH OF LINES , U �\ L�50 DISTANCE TO NEAREST WELL i fl FOUNDATION tJ ft PROPERTY LINE �J�J ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft 1 ,� DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERLY LINE ft ❑ MOUNDED WIDTHft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE R ❑ SUMPS WIDTH_fl LENGTH It DEPTH It i ' DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE R ❑ DISPOSAL PONDS Wmnl ft LENGTH p DEPTH ft SEEPAGE PITS DISTANCE TO NEAREST �� WELL A FO+ 7ATION ft PROPERTY LINE NUMBER i '} �ft Wmrx J �{;7^^ (^^l DEPTH ft DISTANCE �+/� TO NEAREST WELL ft FOUNDATION 1W ft PROPERTY LINE 0 It I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. >� SIGNE AV �l L AO MI 'IMl M1�7It IigUA�1'�NGE NOTFCE REQUIRERFOR INS ' IONS-PLE SE CALL(209)953.7697 JY'Yl J\�Ylf 11v1�� TITL DATE t rinA Insp" Accepted Fiml Inspection B% c;e Character of Solt to Depth of 3 Ft: COMMENTS (21.-0 t v /N✓��clJ L��/t I�sG !f PE SC Received Code INFO B 4-2 -19 42-02-001--r-�{-r 12222003 DEPARTMENT USE NL " �MEN7 t� to Z1 '?C) Area `2-1 2 Employee ID# °3 && to ❑ SPECIAL PERMIT -Approved by zap PitlSump Sail Character: 022.4 O 3" Leo v.I7i�Ny5 yccht//7al--nib FoA° 2Vfp // at. I Date I _ Permit/ r -� o:)