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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 96202-I209)468-3420 <br /> NON-REFUNDA13LE PERMIT CALL(209)9353-7697 FOR IJVSPEC77ONS ExPiRES 1 YEAR FROM DATE ISSUED <br /> JOB ADORES -1A-q!Y,,3 ..........56;Z1 J41 I/) 1-1, J�`y] C�mAjzP <br /> CROSS STREET ��r i!�.�. ry �J APN PANCEL SIZE 02/0�` <br /> OWNER NAME • 1'urJ. ZL/J PHONE <br /> OWNER ADDRESS ���� Ctrt7STATEMP <br /> CONTRACTOR.�„.d/, �.27lei. PHONE/5✓'r—C)9:7 <br /> CONTRACTOR ADDREss ��C,I�� l� CITYISTATFJZAP_,,,�.•arCt.' <br /> LICENSE hilk-42 QC-36 OTHER NUMBER SJ.Y.I; EXPIRATION DATE <br /> WATER TABLE clm: it GEOGRAPHICAL INFORMATION: Coordinates X Y J i <br /> li PERC TEST # BUILDING PERMrr# LAND USE APPLICATION# 1 <br /> TYPE OF WORK: NEW INSTALLATItMJ U REPAWADINT*N 0 ENGINEER DESiGNE07ALTERNAflVa <br /> REPLACEMENT i OUT-Of-SERVICE SEPTIC SYSTEM D DESTRUCTION <br /> INSTALLATION WILL SERVE: 1 RESIDENCE COMMERCIAL Ci OTHER <br /> NUMBER OF LIVING UNITS: P NUMBER OF BEDROOMS: y NUMBER Of EMPLOYEES: <br /> SEPTIC TANK T/PEIMFG CAPACITY gal #OF COMPARTMENTS <br /> L7 GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS ' <br /> DISTANCE TO NEAREST: WELL 7/�. ft FOUNDATION 12 �........ R PROPERTY LINE N <br /> CI LIFT STATION SIZE TYPE OF PIMP U PKG TX PLANT 0 SAND OIL SEPARATOR{ENCLOSED SYSTEM) <br /> It LEACH LINES C LEACHING CHAMBERS #OF LINES . LENGTH OF LIMES !Q ft <br /> .. DISTANCE TO NEAREST WELL ,�s R FOUNDATION J .., it PROPERTY LINES J g it <br /> El FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> CI MOUNDED Ww" ft LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft <br /> C3 SUMPS WwTH ft LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> 13 DISPOSAL PONDS Worm it LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br /> -0 SEEPAGE PITS NuwwR � W10TH 3 it DEPTH ,0 o ft <br /> DISTANCE TO NEAREST WELL J!s� ft FOUNDATION ��..._... it PROPERTY LINE �s ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE W ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE IZEQUIRED FOR INSPECTIONS-PLEASE CALL fZ091 953-7 97 � <br /> SIGNED TITLE L°` .. DATE <br /> Do <br /> L <br /> yI }3j <br /> bk E <br /> 1 <br /> AEPAR7iNEIT <br /> Application Accepted _ Date_ Area Employee iD# <br /> Final Ins pection B °" Date �' �' � CJ SPECIAL PERMIT-Applovad by <br /> Character of Soil to of 3 Pt: PW&mp Soil Character: <br /> COMMENTS <br /> PE SC Received Ch®ccw Amount Parm iU <br /> Code two 8 Cos Remitted Date Service Re u+aruttYl Invoice# Permit ID# <br /> -A7 "I' L L24 4�14 <br /> az oT ONSITE WASTEWATER TRIMUT SYSTEM PERMIT <br /> vnlr�o <br />