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ONSITE WAST'-'ATER TREATMENT SYSTF"PERMIT ' J ..t?u1N COUNTY ENVIRONMENTAL,11VAI;11 Dy--A •rwwr 304 E WmwR AVE; ""FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL(;A)953-7697 FOR INSPECTIONS EXPIRIES.1YEAR FROM DATE ISSUED r JOB ADDRESS CITY/ZIP S {`�FGCS P-A-,j 64 Y� APN � —Q w CROSS STREET OWNER NAME ` ti PH - OWNER ADDRESSfL��t f r M( oto CITYISTATEIZIP_�o�l .A,. A CONTRACTOR { PHONE .ADDRESS CITYISTATEIZIP G.. LICENSE 0 C-42 L3 C-36 OTHER NUMBER EXPIRATION DATE jWLTI ERT�HLE �1 — TI - ft GEOGRAPHICAL INFORMATION: Coordinates X °� Y � PERBUILDING PERMIT# LAND USE APPLICAONS# TYPE OF WORK: L3NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ; ❑ REPLACEMENT ❑ DESTRUCTION {l '`-�`II INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHERS•{i'.?}v� 'A ...,, NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF E'MP' YEES: ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS CAPACITY gal #OF COMP TMENTS ❑ GREASE TRAP TYPEJMFG .).A+I�p ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft ' PROPBRTYzLINE r` R E3 LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARA`FOR(�NCLOS' SYSTEM} V-+ Ii SIS '! ❑ LEACH LINES C) LEACHING CHAMBERS #OF LINES LENGTH OF'LIN65 r '`{ ft z DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE, ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft i DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft f u ft ❑ MOUNDED WIDTH ft LENGTH R DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH-.._ _._,_ ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE, ft i tsL1 ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ,} DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE. ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY:I'I;1"x.111{:':; INI M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSP TIONS-P ,EASE C LL(209 . 3;7697i 1 I �� � SIGNE TITLE I DATE l 'I `f. .'ire �• f I� i It ! is ,?f 6i `Ii ilk a' �I. - Q 1r n � 1 DEPARTMENT USE ONLY 1� -�� Date ��L'S Area Employee iD# f Application Accepted By r« .11w,.4 ,01, Final inspection Date ,i��/as ❑ SPECIAL PERMITI-Approve4,lby y.. .: kCharacter of Sol epth of 3 t: Pit/Sump Soil Character:- COMMENTS j { Permit/ PE Sc Received Chec Amount Date vo Permit lD# Code INFO B Cash Remitted Service Re uest# o� Roo 2.-ii sz ONSITE WASTEWATER PERIb1T }