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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT rn <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH.DEPARTMENT 304 E WEBER AVE-3-FL-STOCKTON CA 952021 1289)465.3420 <br /> NON-REFUNDABLE PErRM�I-T{'• CALL(249 953-7697 FOR.IN PECTIONS CEXPIRESS I YEAR FROM.DATE ISSUED JOB ADDRESS fd iOJ�AI. ee-otic f_ _KL/ CITY/ZIP .3TO full) <br /> �1. <br /> CROSS STREET ° Gi leo( 7Y./ APN UA /30-1-7 PARC.ELSgE <br /> OWNER NAME. dog-A-16- Po b 4e PHONE <br /> OWNERADDRESS CITY/STATFJZIP GG <br /> CONTRACTOR PI 'tv. PHONE Otl <br /> CONTRACTOR ADDRESS CITYISTATE/ZIP - •> <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER 5 EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICALINFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# r LAND USE APPLICATION# <br /> TYPE OF WORK: 'N EW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT (3 DESTRUCTION <br /> INSTALLATION WILL SERVE: DVpESIDENCE ❑ COMMERCIAL L3 OTHER <br /> NUMBEROF LIVING UNAS. NUMBER OF BEDROOMS: l NVMBEROFEMPLOYEES: <br /> Jn�1 <br /> Er SEPTIC TANK TTPEIMFG r tL- CAPACITY�LO tl gal #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPFJMFG CAPACITY / Sal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL It FOUNDATION l 61 it PROPERTY LINE �-$� it S <br /> O LIFT STATION SIZE TYPEOFPUMP ❑ SAND OIL SEPARATORANCLOSED SYSTEM) <br /> (D/LEACHLINES O LEACHING CHAMBERS #oFLINESLENGTH OF LINES <br /> DISTANCETONEAREST WELL ft FOUNDATION IDI fl PROPERTY LINE 75+ R <br /> Cl FILTER BED wmrx R LENGTH, It DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY UNE ft. <br /> ❑ MOUNDED WIDTH ft LENGTH it DEPTH. ft m' <br /> DtSTANCETO NEAREST WELL. R FOUNDATION ft PROPERTY UNE ft fi <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH ft A <br /> Iq <br /> DISTANCETO NEAREST WELL '$ FOUNDATION—ft PROPERTY LINE it IVa <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH. it DEPTH ft <br /> DISTANCE TONEAREST WELL it FOUNDATION _ft PROPERTY LME ft <br /> Q�SEEPAGE PITS NUMBER 3 win; L1,.1 It uePTH ,�.$ I fl <br /> DISTANCE To NEAREST WELL FOUNDATION 101 it PROPERTY LINE'Z5 -ft <br /> • I HEREBY CERTIFY THAT I.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 COUNTY- <br /> MINIM UM <br /> OUNTY.MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL.(2O9)9937697 <br /> SIGNED L<N I�+PTITLE 641A'N4G7t':a'i~ DATE <br /> - FWMA[�NTII <br /> E DVE D <br /> D <br /> of <br /> es <br /> I � <br /> I--10 <br /> DEPARTMENT Y - <br /> Application Accepted Date 1 Q�tO Area _—T ...Employee 1D# <br /> Final Inspection By e? ❑ SPECIAL PERMIT-:Approved by <br /> Character at Sell t;lipidh o(3 Ft: PitlSump Soil Character: <br /> COMMENTS Cx J t-. or— 4-Fr y,tJ 4 OLL,1,0" S NETTCd 06) 1./I?fcr& ,+-r—n-gA OF 6P 91 Erni C)CF <br /> ?Lw AT wF- I-c Ly 'r?7d Au. I1' 84-tFh?60 rNCCEL`$Yt OGtfs�rn.I AT PAC- <br /> PE SC Received ecAmount Permit/ involve# Permit ID# <br /> Collo INFO B ash Remitted Date Service Reg nest# <br /> • 2,. icz / Ser•trt) ° 20© `+ U`# <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 12/22nOD3 <br />