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ONSITE WASTEWAf"'-"'t TREATMENT SYSTEM PERMIT n <br /> n SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT. 304E WEBER AVE-3"FL-STOCKTON CA,. (209)468-3420 <br /> NON-RFFUNDABLE (PERMIT CALL(209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS L��J $�l7 1 r-� . CITYI7,IP _ x N'-''f <br /> CROSS STREET �.{Ij, APNy T 1 V � PARCELSIZE <br /> OWNER NAME 7� ( V PHONE `�d� ly f 1_ FILE C <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR I v O �- PIIONE <br /> CONTRACTOR ADDRESS CITYISTATEIZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: 11 GEOGRAPHICALINFORMATIOF: Coordinates X <br /> PERC TEST # BUILDING PERbfIT# LAND USE APPLICATION# -p <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED(ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILLSERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NOM BER OF LIVING UNITS: NUM HER OF BEDROOMS: NUMHER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPrJMFG CAPACITY <br /> gad #OF COMPARTMENTS <br /> ❑ CREASE TRAP TYPE/MF(; CAPACITY <br /> gai #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE,TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE D <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #of LINES LENGTH OF LINES ft G <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft t <br /> ❑ FILTER RED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH fl LENGTH D DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft J <br /> ❑ SUMPS WIDTH n LENGTH D DEPTH ft <br /> DISTANCE TONEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE D <br /> ❑ <br /> SEE PACE PITS NUMBER WIDTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION D PROPERTY LINE ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONL IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> MINI , 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE.CALL(209)953-7697 <br /> SIGNED TITLE �T-tz7✓4,-'T-f-tl DATE ✓ <br /> IN f <br /> I fill <br /> it e <br /> f -r: <br /> I <br /> 1 0 <br /> k <br /> � N 3t <br /> C� <br /> DEPARTMENT 14SE O LY <br /> L Application Accepted By Date �7 °J ) Area ©� Employee lD# <br /> Final Inspection By ...C4C. Duce "f!/J��( ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 FI: Pit/Sump Soil Character; <br /> COMMENTS r/ <br /> s <br /> Code <br /> Sc Received Chec- ! Amount pale Permit! Invoice# Permit ID# <br /> Code INFO By ash Rrmitu(m Service Re nest# <br /> S 2.f� 9 H,o o �h o� i?M 53 3 r <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> 1222/2603 , <br />