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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> �- SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS WEBER AVE -3""FL-STOCKTON CA 95202 - (209)468-3420 <br />€ ! /_ { � Q� EXPIRES 1 YEAR FROM DATE ISSUED <br /> E JOB ADDRESS �.r1 7�1L{7Q i�-I t "1 CITY/ZIP lel l y <br /> CROSS STREET L-7LI)E ON K �f <br /> �^ ` APN Q l r/ �O `-�� PARCEL SIZE M> <br /> OWNER NAMEi¢ -L - C,/[1J� I�-�j' � <br /> I PHONE <br /> --'OWNER ADDRESS �! <br /> CITY/STATE/ZIP <br /> CONTRACTOR - i ' s� <br />! 4 � PHONE \• <br /> CONTRACIORADDRESS 1 , Y►V CITY/STATEIZIPF--�� CA Q+15'O5 <br /> LICENSE �C 42 ❑C-36 OTHER NUMBER�5 `5� �.) <br /> 'WATER TABLE DEPTH: EXPIRATION DATE G� GSC �J <br /> ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> -❑ PERC TEST(S) NUMBER <br /> LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATIONImo, <br /> `isH REPAIiiIADDITION ❑ <br /> REPLACEMENT ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ ❑ DESTRUCTION CCC <br /> =INSTALLATION WILL SERVE: <br /> ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS:_ NUMBER OF BEDROOMS: „{N <br /> NUMBER OF EMPLOYEES: �tJ <br /> SEPTIC TANK TYPE/MFG ( 4 L — Q <br /> CAPACITY gal #OF COMPARTMENTS <br /> �❑ GREASE TRAP TYPE/MFG <br /> CAPACITY� <br /> gal #OF COMPARTMENTS <br /> PKG TX PLANT DISTANCE TO NEAREST: WELL , 11 <br /> s ,.�� ft FOUNDATION �d , ft PROPERTY LINE i�� <br /> LIFT STATION SIZE ft <br /> TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS <br /> � #OF LINES LENGTH OF LINES <br /> DISTANCE TO NEAREST WELLft <br /> R FOUNDATION <br /> E) FILTER BED WIDTH ft LENGTH PROPERTY LINE ft <br /> 4­1 R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION <br /> R DEPTH <br /> I] MOUNDED WIDTH ft PROPERTY LINE <br /> R LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft <br /> SUMPS R <br /> T J ft PROPERTY LINE <br /> WIDTH ft LENGTH �� f <br /> ft DEPTH__ ft <br /> DISTANCE TO NEAREST WELL . 'f ft FOUNDATION - <br /> _❑ DISPOSAL PONDS WIDTH ft PROPERTY LINE f ft <br /> R LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELLft <br /> ft FOUNDATION ft PROPERTY LINE <br /> II ft LENGTH SEEPAGE PITS WIDTH ft <br /> ft DEPTH <br /> DISTANCE TO NEAREST WELL ��-t} FOUNDATION ft <br /> ft PROPERTY LINE ft <br /> 1-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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> ' •='GNED - <br /> I TITLE DATE ` O <br /> i '— <br /> PL 1252 (E)PROPOSE <br /> k rDra> 1 RES! ! Q G I <br /> GARAGE(E)rr <br /> ¢O'fr on �� —� RESID.(E) i <br /> RESID.(E) <br /> ! I (E) FENCE <br /> PROPOSED B'x <br /> i - _ O s rEjek 50'FADrus <br /> Y <br /> WELL PAs <br /> REO <br /> I S I 50'fuDrtr <br /> I - ;-� ,_-40 AJOV <br /> GARAGE ) i ! a <br /> R SID.(E) SAN JQACU1 �= <br /> i EN\nq J <br /> ARBO (E)-' 38 <br /> I ! 0 HEALTH <br />