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ONSITE WAST,,,..,YATER TREATMENT SYST PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MA TREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 3 e r CITY/ZIP p`I`Q 15177 <br /> CROSS STREET i diI- (! A�PrN`1�{.f f' CJ PARCEL SIZE o <br /> OWNER NAME [� tv <br /> V'Z ry,� 1 J 1 C�V. 'V PHONE �/ 1 � ��� / <br /> OWNER ADDRESS 6 � � CITY/STATE/ZIP rfl L 4 53`7 G <br /> CONTRACTOR -i 3r PHONE <br /> CONTRACTOR ADDRESS D.L 000 �I r�'Vi CffY/STATE/ZIP <br /> LICENSE 0 C42 0 C-36 OTHER NUMBE <br /> EXPIRATION DATE6U 4 <br /> WATER TABLE DEPTH: 77 ��jIg <br /> 47 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 0 PERC TEST # BUILDING PERMIT# 090'4962 LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION Q REPAIR/ADDITION 0 ENGINEER DESIGNED/ALTERNATIVE <br /> 0 REPLACEMENT O DESTRUCTION <br /> INSTALLATION WILL SERVE: O RESIDENCE O COMMERCIAL OTHER au r <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: r NUMBER or EmpLOYEES: <br /> SEPTIC TANK TYPE/MFG �P�*IL �.C+I.1 LfC? Q, CAPACITY + L_-Kal #F OF COMPARTMENTS <br /> GREASE TRAP TYPE/MFG -r Z7J lr CAPACITY gal #OF COMPARTMENTS 3 <br /> DISTANCE To NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> LIFT STATION SIZE TYPE OF PUMP \ O PKC TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> L <br /> O LEACH DINES 0 LEACHING CHAMBERS #OF 6 <br /> LINES LENGTH OF LINES <br /> 4/w ft <br /> DISTANCE TO NEAREST WELL, ft FOUNDATION ft PROPERTY LINE ft <br /> 0 FILTER BED WIDTH 3" ft L G H %S ft DEPTH %. ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ff <br /> MOUNDED WIDTH �O ft ���ft <br /> � ft DEPTH ft <br /> DISTANCE TO NEAREST WELL FOUNDATION ft PROPERTY LINE ft <br /> O SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL 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 /> 0 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> ti i /1 <br /> MI UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)953-7697 <br /> D <br /> SIGNE <br /> i TITLE DATE <br /> i <br /> r� 4 <br /> 1 <br /> 1 <br /> t3 <br /> J ' <br /> �} <br /> SPN JOA, UI <br /> LNVIrl q TIV ElV <br /> EPARTM.ENT E O <br /> Application Accepted B. Date Area Employee ID# <br /> Final inspection By Date Q 13 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: orP' Sump Soil Character: <br /> O NTS 3- <br /> -7 <br /> PE SC Received Che Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> (too . `/ <br /> 42-01 ONSITE WASTEWATER PERMIT <br /> ncnnrinm <br />