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r7 I <br /> F1 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 C WEBER AvE-3°"FL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-711 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> ^I JOB ADDRESS f 4 !' �? + CITVIZIP L 01-k4 C- �L( <br /> fff# m <br /> i <br /> CROSS STREET �L' I✓�f:�.V A�1 APN �` J`'-,li+ l 4' PARCEL SIZE �c�(4./'=; f O <br /> r <br /> OWNER NAME r + i.'1( PHONE m <br /> T !r <br /> h <br /> r� <br /> g OWNER ADDRESS CITYISTATUZI P <br /> 1 c <br /> CONTRACTOR �+�'v i� I/ �JN�r✓:p)'1 PHONE -3L 7 •- 7'? <br /> -+ 1 <br /> CONTRALTOR ADDRESS =-i G 1.- J w f#L/z 'f f a( WZ4 v CITYISTATEIZIP <br /> 1 f LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br />�j WATER TABLE DEPTH: ti GEOGRAPHICALINFORMATION: Coordinates X Y <br /> �. PERC TEST # BUILDING PERMIT# LAND USE APPLICATION#( ); - <br /> TYPE OF WORK: ❑ NEW INSTALLATION' ❑ RLPAIR/ADDITION ❑ ENGINEERDESICNEDIALTERNATIVE `l <br /> iV ❑ REPLACEMENT ❑ DESTRUCTION <br /> l <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> -+� NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: N UMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPFIMFG CAPACITY gal 9 OF COMPARTMENTS <br /> ' ❑ GREASE TRAP TVPFJMFG CAPACITY gal #OF COMPARTMENTS <br /> I <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ LIFT STATION SIZE - TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ~4 <br /> yIy ❑ LEACH LINES ❑ LEACHING CHAMBERS #Of LINES LENGTH OF LINES ft <br /> F DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH B LENGTH ft DEPTR ft �'•� <br /> r DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> 1 DI57'ANCETO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDA71ON fl PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION A PROPERTY LINE R <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COli <br /> p i j M[NIM <br /> UUM 24 NO OTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(709p 453.7697 / ! <br /> SIGNED ��f - Jl" �` TITLE f�f C-��'� (�C- DATE <br /> t T. <br /> F1 <br /> ti} f- <br /> L <br />� I 1 <br /> i <br /> ! a N10.1 <br /> I' D P <br /> CF v <br /> EPARTMISE ONLY 1.J <br /> Application Accepted By ENT_ Date l2 711 If - Area. Employee IDN •r h.I c Y1� j7 <br /> a Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> { <br /> ...' Character of Soi!to Depth oF3 Ft: PitlSump SDlI Character: <br /> COMMENTS <br /> I <br /> f PC LZLSC Received 1-Cheekt Amount Permit! / <br /> Code rr[NrDrr �.Bf f' Cash ,Remitted �7 DateService Re uest# invoice# Permit IDk <br /> 42A2-041 <br /> ONSITE WASTi <br /> 12!22!2403 <br />