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ONSITE WAS ';WATER TREATMENT SYSr)M PtitMIT j FL STOCKTON CA 45202 - (209)468-342D SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH«_.ARTMENT 3041;WEBER. :.E 3k° NON-REFUNDABLE PERMIT ...CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE-ISSUED. JOBADDRESS ' =I i_ �'`�° YFLO' 1 �� CIT_Y_IZIP Trrk. cc. 53 - — a rt � APN � 06,L)-- PARCELSIZE ` CROSS STREET � p _ o OWNER NAME ✓C U z-&-n �Qf 9 - '� C c-0.. PHONE:I I vi OWNER ADDRESS CITYISTATEIZIP CONTRACTOR ] PHONE CONTRACTORADDRESS J PPA CITYISTATEIZIP lNUMBER EXPIRATION DATE LICENSE CIC-42 ❑C-36 OTHER WATER TABLE DEPTH: ft GEOGRAPHICAL[NFORMATION: Coordinates X Y ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# Ii TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADDITION ❑ ENG NEEIt DES]GNEDI!ALTERNATIVE REPLACEMEN6-F1 ❑ DESTRUCTION INSTALLATION WILL SERVE: ss ❑.RESI ENCE D COMMERCIAL ❑ 01 R iI NUMBEROFLIVING UNITS: 1 NUMBER OF,BEDROOMS: - — NUMBER OF EMPLOYEES: �i r Y PTC TANTYPEIMFGI +-r f1 e�' � Y v gat' #OF COMPARTMENTS SEIK CAPACIT © GREASE TRAP TYPEJMFG CAPACITY gal 4 OF COMPARTMENTS ❑ PKG TX PLANT DISTANCE TO NEAREST:. WELL ft FOUNDATION ft PRQPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP © SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH.OF LINES DISTANCE TO NEAREST . WELL ft FOUNDATION ft °(PROPERTY LINE iI ft ❑ FILTER BED WIDTH ft 'LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ MOUNDED WIDTH ft LENGTH ft DEPTH Ii ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH 'I ft- DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft 13DISPOSAL PONDS WIDTH ft LENGTH ftDEPTH j ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ SEEPAGE PITS WIDTH ft LENGTH ft DEPTH ft' DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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. MINIMUM 24"rR ADVANC TICE REQUIRED FOR INSPECTIONS--PLEASE CALL(209)953-7697 , SIGNED TITLE L/ "�w — DATE 71 is �N i I . hVNEWa 60L tg PN 0y, o M iss i , N TJ i dEPARTMENT USE ONL i� Application Accepted By Area Employee ID# I�/I ' Final Inspection By IJ .0. L7 SPECIAL PERMIT-ApprovecE by' !, f Character of Soil ko epth of 3 Ft: PMS mp.Soracter: COMMENTS a t '� &g `�- ii 01 u PE Sc Received Check!/ AmountDate Permit! Invoice# Permit 1D# Code INFO B s Remitted Service Request# � 4201-001 ONSITE WASTEWATER PERMIT znloz . .