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SAJ HE INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: x RESIDENCE COMMERCIAL OTHER NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL _ ❑ LIFTSTATION SIZE TYPE OF PUMP CAPACITY t1 p QG 981 # OF COMPARTMENTS_ CAPACITY (JB1 # OF COMPARTMENTS ft FOUNDATION ft PROPERTY LINA ft ❑ PKG TX PLANT U SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS # OF LINES -;k LENGTH OF LINES ��]/� \� It DISTANCE TO NEAREST VVFLL i DO ft FOUNDATION_ft PROPERTY LINE 1`1 ❑ FILTER BED WIDTH ft LENGTH ft DEPTH tt DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE fl SUMPS c Z) WIDTH a ft LENGTH a. U It DEPTH h It DISTANCE TO NEAREST WELL t FOUNDATION ft PROPERTY LINES H ❑ DISPOSAL PONDS WIDTH ft LENGTH __ I _ft DEPTH ft DISTANCE TO NEAREST WELL I FO NDATION fl PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH fl DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE L. WS AND RUL, AND REGULATIONS OF SAN JOAQUIN COUNTY. N�tM+I�( n SIGNED Y 1U HO R� E/ R FO TLE PEC I -�EA CALL 09)951-7E37 J� DATE 1 PE SC Received Check#I Amount Date PO'm Invoice # Permit ID# Code INFO By Cash Remitted Service RecLuest# 42-01 1014'07 �BT,-S 7 ONSITE WASTEWATER TRTMNT SYSTEM PERM.T -p"- ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue-STOCKTON CA 95205.6232 -(209) 468-3420 NON-REFUNDABLE PERMIT CALL 209 953-76997 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE[ JOB ADDRESS 5 ( C. CITYIZI/P5 1 -1t� cl ^ '- / CROSS STREET I J 1 " 0 1 APN /N� � ham+, - 0 v PCEL 12E AR L -r -Nt I F,Orui � OWNER NAME OWNERADDRESS{^��L�J/V CITSTE/ZIP PHONE C-��/(��rQ(_ CONTRACTOR \ 1'l�� ` 1l/T� Cm- r�T% j' CONTRACTOR ADDRESS COC O �,� I\ J �\ I�yj Jl \lT V J� C CITYISTATFJZIP \ ` IL l J -7 1� LICENSE , C42 - C-36 OTHER NUMBER I `:� EXPIRATION DATE WATFR TABLE DEPTH: %tJ LJ t GEOGRAPHICAL INFORMATION: COOfdin s X Y PERC TEST # BUILDING PERMIT # AND USE APPLICATION # TYPE OF WORK: 7, NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED IALTERNATNE REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: x RESIDENCE COMMERCIAL OTHER NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL _ ❑ LIFTSTATION SIZE TYPE OF PUMP CAPACITY t1 p QG 981 # OF COMPARTMENTS_ CAPACITY (JB1 # OF COMPARTMENTS ft FOUNDATION ft PROPERTY LINA ft ❑ PKG TX PLANT U SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS # OF LINES -;k LENGTH OF LINES ��]/� \� It DISTANCE TO NEAREST VVFLL i DO ft FOUNDATION_ft PROPERTY LINE 1`1 ❑ FILTER BED WIDTH ft LENGTH ft DEPTH tt DISTANCE TO NEAREST WELL fl FOUNDATION R PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE fl SUMPS c Z) WIDTH a ft LENGTH a. U It DEPTH h It DISTANCE TO NEAREST WELL t FOUNDATION ft PROPERTY LINES H ❑ DISPOSAL PONDS WIDTH ft LENGTH __ I _ft DEPTH ft DISTANCE TO NEAREST WELL I FO NDATION fl PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH fl DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE L. WS AND RUL, AND REGULATIONS OF SAN JOAQUIN COUNTY. N�tM+I�( n SIGNED Y 1U HO R� E/ R FO TLE PEC I -�EA CALL 09)951-7E37 J� DATE 1 PE SC Received Check#I Amount Date PO'm Invoice # Permit ID# Code INFO By Cash Remitted Service RecLuest# 42-01 1014'07 �BT,-S 7 ONSITE WASTEWATER TRTMNT SYSTEM PERM.T