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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 96206-(209)438-3420 <br /> NON-REFUND B l CALL 209 9 3-7697 i oR 1NsPEcno IRS t.Wg FROM DATE 1 UED <br /> Joe AoDRESS Cm a <br /> CROSS STREET APN 0 PARCELS o <br /> OWNER NAME PHONE y1-1 _5 <br /> OWNER ADOR S w *'�� CITYISTATEIZIP `p �'W' <br /> . 45215- <br /> CONTRACTOR PHONE '�'.�' <br /> CONTRACTOR ADORESS CITYISTATEIZIP /t <br /> 05 <br /> LICENSE C-42 i.....;C-33 OTHER NUM8@ EXPIRATION DATE <br /> WATER TABLE DEPTH: - ft GEOGRAPHICAL INFORMATION: COOrdinat" X Y <br /> KJA <br /> t] PERC TEST # BUILDING PERMTT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DE$IGNED 0 <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION L� <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERq AL i.; OTHER <br /> NuMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLO <br /> U SEPTIC TANK TYPO&G CAPACITY T� )- gat S OF COMP IFQ�T <br /> C) GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> U LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT U SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES 1< LEACHING CHAMBERS _--- i!OF LINES LENGTH OF LINES D J ft <br /> DISTANCE TO NEAREST WELL ,,,_ It FOUNDATION Z4 ft PROPERTY LINE it <br /> U FILTER BED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> U MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> SUMPS WIDTH ft WE _� DEPTH it <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE R <br /> U DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> U SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE R <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES; <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> ri R I E E CALL 2 3- 8 7 <br /> TITL DATE <br /> L! <br /> Application Aces Area Employee ID#�L L <br /> Final inspection Data L / SPE IAL ERMIT-Approved by <br /> Character of Soil to De of 3 Ft: Pif/Sump Soli Character: <br /> COMMENTS <br /> PE SC Received Chee Amount Data Perrrllti Invoke tk permit IDi <br /> Code INFO Remitted Service R oast# <br /> ,,,200 73Cv tc� <br /> 42-01 ONStTE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4124112 <br /> ... .m:.:. ............ A <br />