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ONSITI ASTEWATER TREATMENT SYSTEM .RMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3'°FL-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT 1 .4 CALL 20�9•F 953-7 97 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS �'aG L I!� ITY2 <br /> •�?' •I-•,t� 1P t1 <br /> CROSS STREET ..s.. - -5, APN +r k�" ✓d 'a'-k h PARCEL SITE t'l I-.•. 7 oT p <br /> OWNERNAME JI�� C.. G. t� ( �:.'=�a4 kip\tt( i::�i'YI�Tl4�� PHONE fkv� •4CF� u, � <br /> OWNER ADDRESS I �'�. -7 t,1 s A 1 d raw�'. d r.:: C 1 `� CITY/STATE/ZIP 'I:i S'(' `- <br /> CONTRACTOR �% PHONE EP q <br /> CONTRACTOR ADDRESS 4 .P !-�a CITY/STATFIZH` / + ~ . <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE V <br /> 1 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> F PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# 0 u <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDmON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT O DESTRUCTION <br /> INSTALLATION WILL SERVE: 13RESIDENCE L3COMMERCIAL 13OTHER 1- <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFO CAPACITY Bal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY 881 #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LME ft 7; <br /> ❑ LIFT STATION SITE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE. ft ' <br /> ❑ FILTER BED WIDTH ft LENGTH fl DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME ft <br /> O SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE.TO NEAREST WELL. ft FOUNDATION, fl. PROPERTY LINE. - ft :. <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH - ft - DEPTH Tft -; <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> --C <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 /> S MINIMUM241HOyRADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 ..•t , <br /> SIGNED 1�"� _ I. a� TITLE /�r�_�.5 .n__� DATE + )�-% J� j. <br /> i <br /> Ls <br /> LC <br /> E <br /> 1 <br /> a <br /> I�DEPARTM NT U� E O i <br /> Application Accepted By_ r(,�%�� ( 1`L Date -� f C11 IV Area Employee ID#-f C G' <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character. <br /> COMMENTS _ <br /> PE SC Received ChecldN AmountDatePermit/ lavoice# Permit ID# <br /> Code INFO B {Remitted Service Request# <br /> 11 � r •�� K �) S .1 �C . y UU Z�� O <br /> 42-02.001 ONSITE WASTEWATER PERMIT <br /> 12lJ2/2003 <br />