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ONSITE WASTEWATER TREATME*Tr SYSTEM PEATO —0,� 7tfI.3 <br /> SAN JOAQUIN CON VIRONMENTAL HEALTH DEPARTMENT WEBER AVE-3Y°FL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7/697 F R INSONS E PIKE 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ✓I CITY/Zp J <br /> CROSS STREET / k - APN OD�)-NO-O ZPARCELSIZE al*�> <br /> ` OWNER NAME,---_--- —'71/7— S�tfb _ <br /> OWNER ADDRESS �f I\ �/� CITY/STATFIZIP <br /> CONTRACTOR ©�AJ'/ J �aLi �Fd/L PHONE CPO /SJ�O A <br /> Q <br /> CONTRACTOR ADDRESS .Or OX /'(� � /CI'T/Y/$TA�ITPIZ/IP <br /> LICENSE A;.42 ❑C-36 OTHER NUMBER T�l' Z!/._J E%)IRATION DATE O SZ <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> hat ❑ PERC TEST(S) NUMBER LAND USE APPLICATION M <br /> TYPE OF WORK: Nl: NEWINITALWTION ❑ REPAIR/ADDITION ❑ ENCINEERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATIONWILLSERVE: IDENCE ❑ COMMERCIAL ❑ OTHER <br /> ` NUMBER OP LIVING JNTTS: //JJ -�,_` NUMBER OF BEDROOMS: NUMBEROFEMPLOVEM: <br /> so�SEPTICTANK TYPE/MFG I.FJAXY�y/b� c,L✓Grd�CAPACT' J�_ gel MOF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFO L CAPACITY/r.0Balll MOFCOMPARTMENTS <br /> ❑ PKGTXPLANT DISTANCETONEAREST: WELL J � R FOUNDATION /fL R PROPERTY LINE �Ed ft <br /> ❑ LIFTSTATION Size TYPEOFPVMp ❑ SAND OIL SEPARATOR(ENCLOSEDD SYSTEM) <br /> in. LEACH LINES 13LEACHING CHAMBERS MOF LINES LENDTHoPLINES ft <br /> DISTANCETONEAREST WELL ISO R FOUNDATION�/`-T ft PROPERTY LINE :F'40 ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> 13 MOUNDED WIDTH fl LENGTH ft DEPTH R <br /> BrR DISTANCE TO NEAREST WELL fl FOUNDATION It PROPERTY LINE It <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> Ran DIWANCETONEunurr WELL ft FOUNDATION ft PROPERTY LME ft <br /> ,Jg SEEPAGE PITS WIDTH 3-5_ R t.E� R - .Y 4 DEPTH a ft <br /> Dinaaw:ETONEAREST WELL e ft FOUNDATION 29-72 R PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI MUM HNOUIt ADVANCE NOTICE R�EQPUI RED FOR INSPE ONS-PLEASE CALL GN)9534697 <br /> SIGNED T J$'�+TITLE DATE 7 /D <br /> 41 1 11 11 <br /> Ji <br /> FETTIVEM <br /> V <br /> ry <br /> r H H FAF17MENT <br /> �l <br /> t..r DEPARTMENT USE ONLY <br /> Application Accepted By Date Aree CQ 1 Z Employee,IDM <br /> Final lnepection By Data ❑ SPE IALPERMIT-Approved by <br /> Character of Soil to Depth of3 F: I PiUSump Soil Character: <br /> COMMENTS <br /> ` PE SC Raelved Ch Amoune Date Periv PermIt,DM <br /> Code INro B Cash Remitted Service Re Reath <br /> 4211 017 1 v 037 1Zo. er 7 �o Qac35clo <br /> Ran 424I-OI <br /> IYL02 ONSITE WASTEWATER PERMIT <br />