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n <br /> r <br /> ONSITE WASTEWATER TREATMENT SYSTi id PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3R"FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7 A FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ✓ AL Q Z CITY/ZIP <br /> St _ <br /> APN;��J� ��g PARCEL SIZE <br /> CROSS STREET C. o <br /> •.G <br /> F OWNER NAME ' V`' "' PHONE ' <br /> i <br /> OWNER ADDRESS ` _ CITY/STATE/ZIP <br /> CONTRACTOR PHONE �j(��r�7 ✓ V <br /> CONTRACTOR ADDRES� {� / I Q �f- Clf� rte_ 'j[C�I[TlYISTATE/Z[P <br /> FLICENSE- 42 ❑C-36 OTHER NUMBER Y 7 �C ZZ�� EXPIRATION DATE <br /> WATER TABLE DEPTH: 490 r R GEOGRAPHICAL INFORMATION: Coordinates X Y — <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> rf TYPE OF WORK: NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OFEMPLOYEES: <br /> SEPTIC TANK TYPE/MFG CAPACITY 1(0[�� .� <br /> �r gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP -TYPE/MFG CAPACITY gal #OF COMPARTMENTS c <br /> d <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL 140 ' ft FOUNDATION • ft PROPERTY LINE • ft <br /> ❑ LIF,T STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> F ❑ LEACH LINES IcT LEACHING CHAMBERS #OF LINES - LENGTH of LINES CU b ft <br /> iz- <br /> DISTANCE TO NEAREST WELL BOO _r't ft FOUNDATION /dD ft PROPERTY LINE <br /> F ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> , DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft F, )NGATION ft PROPERTY LINE ft <br /> [ k ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Fjd--"SE-EPAGE PITS WIDTH `ift LENGTH f} DEPTH —;k__'57 ft <br /> DISTANCE TO NEAREST WELL el!�b ft FOUNDATION f� • -f 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 /> ` III <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MIN 24 HOUR ADVANCE NOTICE_ REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 G� <br /> r <br /> SIGNE TITLE DATE <br /> loo <br /> F _ I 11-t • _ ..�. _ M <br /> d,. <br /> IFdui <br /> { <br /> to ice' <br /> � . <br /> PIJ LIC EA TH <br /> Iti <br /> +WE J IAl HFJI TH P Jl (if <br /> I / <br />