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i ONSITE WASTV"ATER TREATMENT SYSTET 'FERMI <br /> a-30/iia <br /> `AN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEAMAENT 304 E WEBER AVE 4- FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I TR FROM DATE ISSUED <br /> n <br /> SOB ADDRESS CI <br /> T <br /> Y/ZIP =1 <br /> 1 L -(.1 C�i / / m <br /> ROSS STREET /�4/pLR�! y p (�I ' APN PARCEL SIZE <br /> OWNERNAME eY! if �C?f PHONE m <br /> WNER ADDRESS 1 � CITY/STATE/ZIP <br /> CONTRACTOR l4e6/ A+, PHONE <br /> TRACTOR ADDRESS CITY/STATE/ZIP 1 cr-- <br /> ON �C�G � <br /> LICENSE C-42 ❑C-36 OTHER NUMBER l q Y 2-2—S— E%PIRATION DATE <br /> VATER TABLE DEPTH: / 4L0/ R _ GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> T� <br /> PERC TEST(S) NUMBER LAND USE APPLICATION# _ <br /> TYPE OF WORK: -W, NEWINSALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT O DESTRUCTION <br /> �PIVSTALLATION WILL SERVE: J ArRESIDENCE ❑ COMMERCIAL ^7 ❑ OTHER <br /> NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> jSEPTIC TANK TYPE/MFG�t�4^J �. "�/ — <br /> lT`! rt1 E"Q" CAPACITY gal 40FCOMPARTMENTS <br /> GREASE TRAP TYPE/MFG rf CAPACITY / ' gal #OF COMPARTMENTS <br /> PKG TX PLANT DISTANCETO NEAREST: WELL V ft FOUNDATION _ ft PROPERTY LINE <br /> U <br /> LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LIt LEACH LINES El LEACHING CHAMBERS cS` #OF LINES 3 LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL �Q �ft FOUNDATION_ft PROPERTY LINE <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> L1 MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ` ❑ SUMPS WIDTH it LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME ft <br /> DISPOSAL PONDS WIDTH ft LENGTH It DEPTH It <br /> DISTANCETO NEAREST WELL ft FOUNDATION It PROPERTY LINE R <br /> L� SEEPAGE PITS WIDTH 3 k fl DEPTH —02S'— I ft <br /> DISTANCE TO NEAREST WELL FOUNDATION it PROPERTY LINE_ ft <br /> 'HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVAN E NOTICE REQUIRED FOR INSPECTIONS- EASE CALL(209)953-7697 <br /> SIGNED O.�' rL� -I/�TLE � DATE <br /> / <br /> _yt mVi <br /> d _ J <br /> I <br /> P oil HE fI.TH SEP.0'E <br /> G - _ <br /> r <br />