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ONSITE WASTEWATER TREATMENT SYSTEM PERMI10t:f5:S'o-� <br /> SANJOAQUIN'COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3'Fl.-STOCKTON CA 95202-(209)46$-342o <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPE.TIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESS Q �.- <br /> CITYJZIPTS rn <br /> /7 ,�-y <br /> CROSS STREET l'��� APN /S/ C/ PARCEL SIZE / pip Cp <br /> i OWNER NAME C,J r ZI L_'J7 a <br /> PHONE "T'OG3 a.3 <br /> OWNER ADDRESS <br /> CITY/STATE/ZIP / r <br /> CONTRACTOR !V �(J I - A. �— PHONE :346 — <br /> 42 <br /> CONTRACTOR ADDRESS 4 CRWSTATErZIP <br /> LICENSE C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X y <br /> ❑ FERC TEST # BUILDING PERMIT# LAND USE APPLICATION# f+ <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDrr1ON ❑ ENGINEER DESKTiED/ALTERNATIVE \ <br /> ❑ REPLACEMENT CI DESTRUCTION <br /> INSTALLATION WILL SERVE: IDENCE ❑ COMMERCIAL ❑ OTHER 3' <br /> NUMBER OF LIVING UNITS: ��// NUMBER OF BEDROOMS: � NUMBER OF EMPLOYEES: 4\ <br /> /, SEPTIC TANK TYPF/MFG 6x/C>>!!y-rs-- ��}.T�/ CAPACITY__, lp�f/j <br /> Sai #pF COMPARTMENTS._ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL O ft FOUNDATION S R PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft \J <br /> DISTANCE To NEAREST WELL FOUNDATION �� <br /> --I—_ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL RFOUNDATION fl <br /> ❑ MOUNDED Wlo7x R LENGTH PROPERTY LINE fl <br /> fl DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TT)NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO N WELL It FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBEitWtDT11 ft DF_PTH It <br /> DISTANCE TO NEAREST WELL it FOL•NDATION �� ft PROPERTY LINE ��— ft <br /> I HEREBY CERTIFY THAT 1 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 /> MI 'I UM 24 OUR A VANC E 'OTI REQUIRED FOR I.VSPECTI( 'S-PLEASE CALI,(209)953-7697 <br /> SIGNED ��/�� TITLE_ DATE <br /> i <br /> JI <br /> leil- <br /> s <br /> 1 <br /> i <br /> E <br /> i N E T <br /> M <br /> i <br /> D <br /> -- PARTMFNT U'S'ONL <br /> ApplicaDon Accepted By le Z Arra Employee ID# <br /> Final IDspection By to ❑ SPECIAL PERMIT-A ` <br /> Approved by <br /> Character of Soil to Depth of 3 Ft: Pi ump Soil Chaster: <br /> CO NTS <br /> eco S <br /> PE SC Received Aewuat Date PermiU <br /> Code IN FD B Cash Remitted ServFix R nest# Invoice# Permit ID# <br /> y I 4-Wo <br /> 42-02-001 <br /> 12222003 ONSITE WASTEWATER PERMIT <br />