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3 ONSITE WAS WATER TREATMENT SYST VIxPERMI�UA ��� <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH. vRTMENT 304 E WEBER r.�. -3 FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT -CALL(M)953-7697 FOR INSPECTIONS {EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS II _/ �Q� '-- .....__�- 1TY/ZIP ✓� - -�6�.� �iS L I .S� i+if <br /> CROSS STREET >�GtyJ G fZLf/� <br /> rf- / ct� APN �©` '�12-6 PARCEL SIZE <br /> OWNER NAME )dq� Zy ij d PHONE <br /> OWNER ADDRESS � ( /Y i r `� � CITY/STATEIZIP q-j-z� <br /> i C)v PHONE <br /> CONTRACTOR <br /> CONTRACTOR ADDRESS Z z ! CITY/STATE/ZIP,�7 <br /> LICENSE ❑C42 XC-36 OTHER �f+ NUMBER�Z3 /r� EXPIRATION DATE 2 43 4S` <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# � <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> rS NUMBER of LIVING UNITS: NUMBER OF BEDROOMS: p NUMBER OF EMPLOYEES: <br /> 7�{ SEPTIC TANK TYPE/MFG C Coq d zt� CAPACITY ( C] gal #OF COMPARTMENTS <br /> ( © GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION it PROPERTY)tNE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP F© SAND OIL SEPARATOR(ENCLOSED SYSTEM) _ <br /> LEACH LINES ❑ LEACHING CHAMBERS #,oF LINES � LENGTH OF LINES �0 ft <br /> DISTANCE TO NEARESTWELL I ' ft FOUNDATION ft PROPERTY LINE III <br /> ❑ FILTER BED WIDTH ft- LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS WIDTH -� ft LENGTH ft DEPTH 2 S� ft <br /> / DISTANCE TO NEAREST DWELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> i STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQU1N.COUNTY. <br /> MINI M 24 HO R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 !, <br /> ' SIGNED TITLEr I-"u-GT cJ1/ DATE / r <br /> i - <br /> �- PAY <br /> AVA <br /> y- / �✓ k <br /> p120pQE'APP 16845Q.SINGLE � \ <br /> FP�fIkLY'RE5lDt3HGE C9 'y_.,.'. <br /> od i- <br /> 172 <br /> 1 <br /> t `Of 'V <br /> �" .ccin.r.w�Nunn <br /> I / 1 "vmq <br /> lit 1 19D - <br /> DEPARTMENT USE[NGLY � <br /> Application Accepted By Date j 1 Area Employee!D# t� <br /> Pinel Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth f 3 Ft: 4 PitlSamp Soil Character: <br /> COMMENTS / S ,GLgrrt <br /> PE SC Received heck#! Amount Permit/ <br /> Code INFO B as Remitted Date Service Request# Invoice# Permit ID# <br /> a1 3 D Cj <br /> � rGsZE-tea i .e� /c.�. �'� s iYf��� F.�•� cU s. .�kas c2cu,�as,ate <br /> 42-.0 0157;io ode .y �j�/1�JG+f 9<�c� KGs rle�l � � ✓J� U 'c�T iS �- )_ �$E WAS EWATER PERMIT <br /> �>�113+1].an1L 1 r-X:gs�Zj 5-f'5'0� ' t lS r Z4- <br /> T�ws:ND.4/! i•J Td_ni!%i.is� r,. /L-r.c�"'���. . i. J.y._- r�r ,1 <br />