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- a <br /> WAWT +TATER TREATMENT S`` _.I-). PERMIT _ <br /> 304 E WEBER Avis3N"FL-STOCKTON CA 95202 - (209)468-3420 <br /> SAN,', IN COUNTY ENV:.-6.,A NTAL HEALTH DEPARTMENT , <br /> ON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> rn <br /> J '?� ,J CITY/ZIP [Yf� <br /> JOBADDRESS ! I� y <br /> �' APN `' _ - � PARCEL SIZE r l�^/7 ° <br /> CROSS,STREETy <br /> I QSGi�r� 111��/1 PHONE <br /> I OWNER NAME <br /> OWNER ADDRESS C[TYISTATEIZIP <br /> CONTRACTOR �•�[ I�1L3�� ,� • � �/�I _ <br /> PHONE o �� Z&65- K Edi <br /> f�f CITYISTATE/ZIP �1-AF <br /> CONTRACTOR ADDRESS C'c3L /�/n.�T �✓ ��LLt� f -� <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER_liu7 ! EXPIRATION DATE <br /> WATER TABLE DEPTH: — <br /> ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) <br /> NUMBER LAND USE APPLICATION# T� '•� <br /> REPAIR/ADDITION ❑ ENGINEERDESIGNEDIALTERNATIVE <br /> TYPE OF WORK: a NEW INSTALLATION ❑ DESTRUCTION <br /> O REPLACEMENT <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE <br /> COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: <br /> NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> '7 <br /> SEPTICTANK TYPE/MFG_?4L CAPACITY gal #OFCOMPARTMENTS !s^ <br /> ❑ <br /> CAPACITY gal #OF COMPARTMENTS <br /> GREASE TRAP TYPE/MFG <br /> ElPKG TX PLANT DISTANCE TO NEAREST: WELL i� FOUNDATION <br /> ft PROPERTY LINE 'i 1-:4 ft <br /> 5 � <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> #OF LINES �— LENGTH OF LINES t'6,I tt <br /> LEACH LINES Z3 LEACHING CHAMBERS <br /> f)[STANCE To NEAREST WELL .3�p -L- ft FOUNDATION eft PROPERTY LINE—1 - ft <br /> ' ft LENGTH ft DEPTH ft <br /> ❑ FILTER BED WIDTH ft PROPERTY LINE ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION <br /> ft <br /> ❑ MOUNDED WIDTH ft LENGTH DEPTH <br /> ft <br /> ft FOUNDATION ft PROPERTY LINE ft <br /> DISTANCE TO NEAREST WELL ft <br /> C3 SUMPS WIDTH ft LENGTH ft DEPTH <br /> ft FOUNDATION ft PROPERTYLINE ft <br /> DISTANCE TO NEAREST WELL �..�- ft <br /> ft LENGTH ft DEPTH_ <br /> 'I ❑ DISPOSAL PONDS WIDTH t7 PROPERTY LINE ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION <br /> ^� ft DEPTH-Z6 ft <br /> SEEPAGE PITS WIDTH '3 ft LENGTH ft <br /> }.� - <br /> DISTANCE TONEAREST WELL s2.�—ft FOUNDATIONS ✓ ft PROPERTY LINE <br /> TY ORDINANCES, <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS <br /> LAWS AND THE WORK WILL BE <br /> AND REGULATIONS OF DONE <br /> AN INA ACCORDANCE <br /> COUNTY.WITH SAN JOAQUIN COUN <br /> ST <br /> MIN M HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS S-PLEASE CALL(209)953 7697 <br /> ✓ ",� , TITLE . <br /> 1I�IPPJJ DATE 1 <br /> SIGNED F <br /> ----- -- I I <br /> rJr!'3T]Nd]-9T(•KT flfall3C • _-----,I I �— <br /> II <br /> 1 <br /> x.w• <br /> 8 1W.ai I F— i�.l <br /> '• -- pl Tp TTO IRrSrrN3.• --- _�_ <br /> 14 P.V�L-_` I TT ® 1MTN1.T :oa3. ID L.P, - 1.•� <br /> •4.0.0] 3T0 vrRirY b•P.v_C. <br /> lAr11GL PTrM <br /> ® RACK TO CC�iTd1LTICN. Rc <br /> 1301—.un— <br /> TNK <br /> 6,y.Rf � • rtN a1N-J+f,l � -- - Mme' <br /> ® pa'T110 ® 1'IN fW 11N.•ar6.3T •• \ (4 <br /> TNs f'CVM(S/ IrN.•f%.M t 'I3i0+r <br /> a3 L.P:- aQ h <br /> Pv,G. 3b P3 X11 <br /> b"Fa1 F $ <br /> +'INV.•T L.O.•i%.3/ V <br /> m c.r. -LFN .LtNE i ti <br /> _ I <br /> I \` <br /> maT tr15rIN5✓r xYM9.Vo T1YP9 .tel <br /> I i _ re:•--I- s r�..�- _ _. ...3�arizn rYK.cwnTN„crrw. _ :. .� -..: � r r_ ,. _r _ , <br /> ' DEPART MENTIJ SE NLY '—. � <br /> Application Accegte <br /> Date O Area Employee ID# . <br /> Date ❑ SPECIAL WRMIT-Approved by <br /> Final Inspection B <br /> PitlSump Soil aracter: <br /> Character of Soil to Depth of 3 Ft: <br /> COMMENTS I <br /> VA <br /> c Amount pate Permit/ voice l Per it rye. <br /> PE 5C Received Service Re uest# <br /> Code INFO B ash Remitted <br /> x'2A/ I <br /> IL <br /> �iM� t^ r Di ONSITE WASTEWATER PERMIT <br /> 42-01-001 1 O '�•d/3�b� n �7' (/ ��'� <br /> r�nlm <br />