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51xc <br /> ONSITE WASTE. ITER TREATMENT SYSTEP 'ERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEAL'Ill DEP�:NT 304 E WEBER AVE aA4'L-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> T <br /> Jo ADDRESS %-� • t/`\ CITY/ZIP "i <br /> Pi�41!/1 ``.GI APN PA TL.% <br /> C SSSTREET G7 PARCEL SIZE <br /> OWNER Nnme c Pxorve y <br /> OWNERADDRESS (�I �/,11-�s 'was'•A ���s�A `yy'��I rw C/IT�Y'/�AATE/ZIP <br /> CONTRACTOR {V-Q1�.7`l �"/•,1rV^y I!/w'\ ry1_[rC;y1y,-V'LI I ` CV • PHHON,( Log g45 <br /> CONTRACTOR ADDRESS_ Y�/ f �/ {Y s' ,' V" '" CITY/STATE/ZIP F�� O I 1&10\ <br /> LICENSE ❑C42 ❑C-36 OTHER ( 1�{/ NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: 11 GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# — —�-3 <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ RE AHVADDITION ❑ ENGINEER DESIGNED/ALTS ATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY pal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY pal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL III FOUNDATION ft PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft W <br /> DISTANCE TO NEARESTa <br /> L FOUNDATION R PROPERTY.LINE ti <br /> O FILTER BED wlDnl NGT' R DEPTH <br /> DISTANCE I'O 'A 'S'TL It FOUNDATION Il PROPERTV.LINE❑ MOUNDED WIDTH LENGTH ti DEPTHDISTANCE TO EARESTL R FOUNDATION H PROPERTY LINE R❑ SUMPS WIDTH LENGTH R DEPTH R ,T <br /> DISTANCE TO FARE WELL R FOUNDATION-ft PROPERTY LINE fl 1 ' <br /> G <br /> ❑ DISPOSAL PONDS WIDTH 1t LENGTH H DEPTH tt h <br /> DISTANCE TO NEAREST WELL H FOUNDATION R PROPERTY LINE fl <br /> Cl SEEPAGE PITS WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> THEREBY ERT Y 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 HOUR ADVANCE NOTICE REQUIRED FOR INS►PPEECCTIIONNSS--PLEASE CALL(209)953-7697 f, / <br /> SIGNED TITLE 1 Tty�r�'GN� DATE tb^� p% <br /> '.O D d a, Ls <br /> A <br /> P v <br /> 3. ar <br /> k �l S <br /> Vl p 1 <br /> r r <br /> DEPARTMENT -E O 'LY s <br /> Application Accepted ByDate 0 O 0 Area Employee ID# <br /> Final Inspection By Date Sy ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS tl l 'LAS �AI�L'EL� ��th 7�STE A.VJ ��i xg AAt9 w v�R1ilF�zt <br /> PE Sc Received Checkgo Amount Date Permit/ Invoice# Permit 1D# r <br /> Code INFO B Remitted Service Request# <br /> ZI2-2y GD 'po5 <br /> 42-01-001 ` <br /> 171102 ONSITE WASTEWATER P, o <br />