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ONSITE WA WATER TREATMENT SYSr- "W PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH D,. kRTMENT 600 E Ms-„ti STREET-STOCKTON CA 95202-(209)468-3420 <br /> I NON-REFUNDABLE/ 4�PrERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS T 9 l,Q, -g' g-e_ . m } <br /> •• ,-, CITY/ZIP (., s y <br /> CROSS STREET JAI_ A _,APN PARCEL SIZE 2-S o <br /> OWNER NAME <br /> PHONE m <br /> CA <br /> OWNER ADDRESS 4kq yn cl l ✓ <br /> CTATEIZIP 1+1 '76 <br /> mitt, ��CONTRACTOR PHONEP4 60)e_teSn <br /> CONTRACTOR ADDRESS If" „ <br /> y <br /> C� Q CITYISTATEIZIP Y; k'l <br /> LICENSE 11C-42 ❑C-36 OTHER _- NUMBER a asq EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: COOrdinate5 X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION <br /> # Apt <br /> TYPE OF WORK: ❑ NEW INSTALLATION EPAIRIADDI710N ❑ ENGINEER DESIGNEDIALTERNATIVE <br /> D REPLACEMENT ❑ DESTRU TION <br /> INSTALLATION WILL SERVE: jZ-kESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> D SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> 0 GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 0'-'LEACH LINES Col"'LEACHING CHAMBERS_ 11; OF LINES LENGTH OF LINES Reft 1 <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION k ft PROPERTY LINE,ko l ft <br /> © FILTER BED WIDTH ft LENGTH ft DEPTH ft (� <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft IN <br /> 13 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL - <br /> ft FOUNDATION ft PROPERTY LINE ft <br /> D DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft (, <br /> DISTANCE TO NEAREST WELL ft 'FOUNDATION ft PROPERTY LINE ft <br /> O SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft. PROPERTY LINE ft <br /> I HEREBY CERTIFYLEFT BMw OF OLD ;OUNTY ORDINANCES, <br /> y <br /> WEINUEN <br /> SHEA TO <br /> SIGNED `27.31 �� 1800 SFt1 <br /> OBD LOT UW <br /> rEw � <br /> r= 5TI <br /> X1NG LINES <br /> X +REMAIN To <br /> YJIT}tltfJar .- <br /> s e� � . <br /> •---------•----------- — -- — ---�— i <br /> Vwu <br /> SAND A Ul C <br /> ENVR N ISN <br /> -� HEAL <br /> DEPARTMENT U EON Y <br /> Application Accepted Area Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to pth of 3 Ft: tlSu <br /> p Soil Character: <br /> COMMENTS L-oT t) F A�_Go -Z . A--V -PA- T n F 'Yo -- a 70 G 401 L-14 aE rs-r7 Aj <br /> r C- -7-n Ate. C_1-t-7- 0 F--- -5- FEE i revs 10� -,-4o.jz��/J <br /> PE SC eceived Chec Amount Date Permit) Invoice# Permit ID# <br /> Code' INFO B Remitted Service Request# <br /> de <br /> 42-01 // ?SITE WASTEWATER TRTMNT SYSTEM PERMlT � <br /> 1014107 <br />