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ONSITE WASTEWATER TREATMENT SYSTEM PERMITSCANED <br /> A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE.-3-FL-STOCKTON CA 95202 - (209)468-3420 <br /> NOS!-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIR�ElS 1 YEAR FROM DATE ISSUED <br /> I ^ / C �• CITYIZIP .SI / G'Cr70— <br /> JOB ADDRESS <br /> APN <br /> CROSS STREET' 6 ,- L--C) > <br /> 37 PARCELSCEE Z. - C <br /> d <br /> OWNER NaM11E PHONE ff`` ` •f �'� L,1i <br /> OWNER ADDRESS yi t31x 1 _ CITY/STATE/ZIP { L.�� 12neq <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS L7e 11 C[TV/STATEIZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER I EXPIRATION DATE / � �r <br /> WATER TABLE DEPTH: ft GEOGRAPHICALINFORMATION: CRUrdinateS X Y <br /> ❑ PERC TEST # - BUILDING PERMIT# --Cys LAND USE APPLICATION <br /> TYPE OF WORK: Ir NE-INSTALLATION ❑ REPAIRIADDITION ❑ ENOINEERDESICNEDIALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: 0 RESIDENCE ❑ COMMERCIAL C1 OTHER <br /> NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPEIMPG r CAPACITY ^� 7.c O gal #OF COMPARTMENTS 7 <br /> ❑ CREASE TRAP TYPEIMFG CAPACITY gal X OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL �c�r A FOUNDATION CJ I A PROPERTY LINE R <br /> ❑ <br /> LIFT STATION SIZE_ TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 21 LEACH LINES ❑ LEACHING CHAMRERS #OF LINES ft LENGTH Of LINES <br /> DISTANCE TO NEAREST wELL �Gtc P FOUNDATION ft PROPERTY LINE <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH R <br /> DISTANCETO NEAREST WELL/0,'-. ft FOUNDATION 7--:5.- ft PROPERTY LINE R ~� <br /> ❑ MOUNDED WIDTH h LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl I <br /> ❑ SUMPS WIDTH_ft LENGTH ft DEPTH R <br /> DISTANCETO NEAREST WELL R FOUNDATION fl PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH fl LENGTH I1 DEPTH ft kk. <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft III <br /> SEEPAGE PITS NUMBER � WTDTH 73 R DEPTH -S ft it <br /> DISTANCE TO NEAREST WELL /S b R FOUNDATION ` _ fi PROPERTY LINE ft Z <br /> 1 HEREBY CERTIFY THAT 1 HAVE,PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAW'S AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE:CALL(209)953-7697 <br /> SIGNED TITLE C�-• �/ Sr - DATE <br /> r <br /> v <br /> I � <br /> I I <br /> N <br /> C <br /> I <br /> I Q <br /> VA I <br /> I ICK <br /> V <br /> O Jq <br /> j4 ICII 4MINA <br /> T D <br /> A Ln <br /> DEPARTMENT U. ON <br /> Application Accepted �' Dale iF. -� S Area Employee lb# <br /> Final Inspection By Date� ❑ SPECIAL PERMIT-Appro�ed by <br /> Character of Soil to Dep of 3 F1: Pit/Sump Soil Character: <br /> COMMENTS HIF-r=i NF-� r_u'7' 1. E <br /> PE SC Received Cheek#/ Amount Date Permit( Emoice# Permit IDH <br /> Code INFO BY as Remitted Servlce Request H <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12122120(0 <br />