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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-1420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIR <br /> E <br /> S 11 YEAR FROM DATE ISSUED <br /> JOB ADDRESS all// CITY/Zip,S f, n <br /> � <br /> CROSS STREET - APN /[r/'"040 -15, PARCEL SIZE I _ 31 <br /> _ s <br /> OWNERNAMEY'llPHONE 40—/ <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> /J <br /> CONTRACTOR /C/r /(i.t/�/, /�/ .I�Clr�,f/ �1�ALG� PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP �SI��Qw/i �Za✓� <br /> LICENSE XC-42 1C-36 OTHER �^-t NUMBER�� 7 EXPIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # l BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADOITION 71 ENGINEER DESIGNED/ALTERNATIVE <br /> _ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: G RESIDENCE t� LOMI/IERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG _ CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL it FOUNDATION ft PROPERTY LINE It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES J; it <br /> i <br /> DISTANCE TO NEAREST WELL ft FOUNDATION /D ft PROPERTY LINE S ft <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH_ It LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER 7 WIDTH y� ft DEPTH ZSr ' / _ft <br /> DISTANCE TO NEAREST WELL ZSZZ�4—ft FOUNDATION J ft PROPERTY LINEi 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 /> MINIMUM 24 H UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED!�/ /_tel TITLE G6 O DATE <br /> JOU <br /> o � <br /> — o <br /> r E <br /> ArtsI <br /> 1 <br /> PARTMENTU E LY <br /> Application Accep Date Area Employee ID# <br /> Final Inspection ---- Date 61 ❑ SPECIAL PERMIT-Approved Dy <br /> Character of Soil to D th of 3 Ft: PIVSump Soil Character: <br /> COMMENTS 1f2t/r P S1r4iJ�I <br /> PE SC ReceivedCh Amount Permit/ <br /> Code INFO B Cash emitted Date Service Request# Invoice# Permit ID# <br /> 42 4 <br /> sl 3$0 3 3 _� <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 10/4/07 <br />