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ONSITE WA -EWATER TREATMENT SY EVI PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HFAL114 DEPARTMENT 304 E WEBER-XVE -3"n FL-STOCKTON CA 95202 - (209)468-3420 <br /> IE <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS, EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS .'��` rt"f _W- CITY/ZIP <br /> �i CROSS STREET ��{fp�?S yi'Lt7 APN /S ,�-j RCEL SIZE ' C- <br /> PA p� <br /> !i C <br /> OWNER NAME <br /> OWNER ADDRESS CITYISTATEIZIP [f�y <br /> f <br /> CONTRACTOR -e -K<� o-� {'e�G PHONE -q-0- <br /> CONTRACTOR ADDRESS O CITY/STATE/ZIP <br /> f� LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> i WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT## [S- d`'CO-513LAND USE APPLICATION## <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> Ei orov REPLACEMENT ❑ DESTRUCTION <br /> ' INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL © OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 1 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG _ CAPACITY gal #OF COMPARTMENTS <br /> I © GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> . f <br /> PKC TX PLANT DISTANCE TO NEAREST: WELL ��� ft FOUNDATION I(�1 ft PROPERTY LINE <br /> j <br /> O LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> i <br /> t p` <br /> CLEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES 100 ft <br /> DISTANCE TO NEAREST WELL --�+#�---=— ft FOUNDATION In 1 ft PROPERTY LINE I ft <br /> O FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> �j ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> I CD SUMPS WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ' <br /> ❑ DISPOSAL PONDS-WIDTH ft LENGTH ft DEPTH ft <br /> 1 4 W6 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> p 0 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> EI I HEREBY CERTIFY THAT 1 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> ? SIGNED TITLE G DATE <br /> ii <br /> 'I I <br /> A J <br /> AC W LC4 4M <br /> i RC NA EN FAL <br /> o <br /> .5 RT�fgjTr <br /> I 1 u <br /> LLL I— <br /> E� <br /> u <br /> ;I <br /> d <br /> DEPARTMENT U. E ONJLY <br /> !i Application Accept d B Date ✓�� Area # Employee iD# <br /> E' Final Inspeetio By Dat ❑ SPECIAL PERMIT-Approved by <br /> Character of:I ept4.f t: ' Pii/Sump Soil Character: <br /> COMMENTS S ' es u•� �. t5aa C f fry Qr �e v <br /> p;PE SC Received, hec Amount Permit/ <br /> i <br /> Code <br /> INFO 'BY ash Remitted Date Service Re uest# Invoice# Permit ID# <br /> -rr ll-7 a oc KG ) Z <br /> ll <br /> ;! 42-02-001 ONSITE WASTEWATER PERMIT <br /> !i <br /> Ii/22/2004 <br />