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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONN1ENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3"FL-STOCKTON CA 95202 - (209)468-3420 <br /> YON-REFUNDAB E P MIT CALL(209)953--'J7697 FOR INSPECTION'S EXPIRES l YEAR FROM DATE ISSUED <br /> JOB ADDRESS nn IG `CITY/ZIP I ti 5,2`10 4 <br /> is c FV e APIA 5 )" 9�O -0 7 d <br /> q ROSS STREET PARCEL SIZE <br /> 0 <br /> -OWNER NAME IDIS S J Ce V t TgAtCI 1 Qt PHONE} <br /> WNER ADDRESS 1007 IWbco3�' t C[TY/STATE/ZIP ry�,y <br /> CONTRACTOR Ion^ ` t ` J (]�,,c "L� to c PHONE ''56- r 60 <br /> CONTRACTORADDRESS ` e" ��'--"" r CITY/STATEIZIP. Lj �� �" ` /95 <br /> 1L <br /> .LICENSE C-42 ❑C-36 OTH1:R/ 1 G'-`' �"" NUMBER � [ � EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinate& X Y <br /> Ia PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> r TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> L <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL L] OTHER f� <br /> _ NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: _ NUMBER OF EMPLOYEES: 7© <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> == <br /> 4-� <br /> LEACH LINES 1� LEACHING CHAMB>RS (5) RC1 #OF LINES LENGTH OF LINES <br /> ft <br /> DISTANCE TO NEAREST WELL _1 In ft FOUNDATION ft PROPERTY LINE ft <br /> F❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> 1 <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE <br /> Y ❑ SUMPS WIDTH ft LENGTH ft DEPTIi R LLJ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> ISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> r r <br /> 4 SEEPAGE PITS C-4 <br /> IDTH ft LENGTH ft DEPTH __ ft <br /> DISTANCE TO NEAREST WELL '�ft FOUNDATION 10 ft PROPERTY LINE S ft <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 /> M[ 24 U AD ANCE NOTICE REQUIRED FORI TIONS- LEASE CALL(209)953-7697 f� <br /> 1. <br /> SICNEI / TITLE DATE V 4 <br /> R11 <br /> P <br />