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ONSITE WAST WATER TREATMENT SYSTr'Nd PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH 15—nRTMENT 304 E WEBER AVS?-3k°FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(249)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE <br /> � IISS-U„E <br /> -�D <br /> JOB ADDRESS J20 C[TY/ZIP 05 0lay) G& 5�o / <br /> ?CROSSSTREET APN 2 ( <br /> v,ILu <br /> 3 12-IFI F .A <br /> OWNER NAME V-z� PHONE �/' y <br /> OWNERADDRESS �f1 •f r CITYISTATE/ZIP_ t �1 �/"C� 7a �o <br /> CONTRACTOR - IGS t�.''GA PHONE '[jt&` <br /> CONTRACTOR ADDRESS ro 4 CITY/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION q2-�REPAIRIADDITION ❑ ENC E WE <br /> S NED TI <br /> El REPLACEMENT ElDESTRucT10N { <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER 1] <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: y NUMBER OF EMPLOYEES: rn <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG 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 ElSAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Ve/LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL �CS ft FOUNDATION I d! ft PROPERTY LINE <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH tt <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE tt <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH `ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE -ft <br /> I HEREBY CERTIFY THAT 1 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 /> NI§IUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED W L/ TITLE r�_f]/Zr c+C�}�(3 DATE C7 <br /> I� N } p <br /> - \ , <br /> PDUI <br /> eX <br /> �f <br /> 1 <br /> r" <br /> E � <br /> '--GG1'A -TN-ENT-USE-ON -- <br /> pf <br /> Application Accepted y Dat- ?� Area ( O _Employee ID#� -7 <br /> Final Inspection B Date ❑ SPECIAL PERMIT-Approved'by <br /> Character of Soil to Depth of 3 Ft: Pi Su p Soil Character: <br /> COMMENTS d i tL L o4- o-( re-c-o <br /> PE SC Received Check#/ u Amount Permit/ <br /> Code INFO B as emitted Dat- ervice Re st# Invoice# Permit ID# <br /> 4-z-10 tf.5 ��' llfi�•Cx7 l <br /> 42-01-001 <br /> 1212/02 ONS[TE WASTEWATER PERMIT <br />