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ONSITE WAS 1 .,,t;TER TREATMENT SYSTRMIT <br /> SAN JOAQIIIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE'-3" L-STOCKTON CA 95202 - (209)465-3420 <br /> NON-REFUNDABLE PERMIT i } CALL I�209 953-76697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS l�I�a��� CITY/ZIPC1,- <br /> CROSS STREET 1 ����I �-I�' 1 I',I1C APN M�1� I Z� Cl"j PARCEL SIZE !l,.C� '�].� _ v <br /> OWNER NnMt �1 �fi C T n/ PHONENo <br /> OWNER ADDRESS ,l � 9 1 Y � CITY/STATE/ZIP j_ cct( ((' <br /> A c^1 X12 <br /> CONTRACTOR I C r l / / C c �� PHONE: <br /> CONTRACTOR ADDRESS C. L:t CITV/STATE,/ZIP L­ <br /> LICENSE. ❑C42 ❑C-36 OTHER NUMBER EXPIRATION DATE. `` I <br /> WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> (� PERC TEST # BUILDING PERMIT# LAND USE APPLICATION#+�; N <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION �J 1 <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL. ❑ OTHER r.,\ <br /> NUMBER OF LIVING UNITS: NUMBER 01:BEDROOMS: NUMBER OF EMPLOYEES: J <br /> ❑ SEPTIC'"TANK TYPE/MI-o CAPACITY ._ _ gal #OFC'OMPARIMIN,rS- _ — <br /> ❑ CREASE TRAP TYPE./MFO --_-- - C'APAc H Y -_- ---- - - — gal POI COMPAR ITIFN I5____-- -- <br /> ❑ PKG TX PLANT DISTANCE.T'O NEAREST: WELL tt FOUNDATION III PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE: TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> L <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES tt <br /> DISTANCE,TO NEAREST WELL ft FOUNDATION ft PROPERTY I INF, ft <br /> ❑ FILTER BED WIDTH ft LF:Nc H _ ft DITIII It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE it <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH It LI+.NGTH fi DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTYI`L it <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE tt <br /> ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH R <br /> DISTANCE TO NEAREST WELL tt FOUNDATION ft PROPERTY LINE it <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 /> M ' M M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLE�&jas, <br /> (2009)953-7697 <br /> SIGN D �ITITLE (i li DATE <br /> 41 <br /> rI <br /> 'OJN�Y <br /> DEPARTMENT USE PNLY <br /> Application Accepted By D l (' Area Employcc ID# '' 4 <br /> Final Inspection By 411" _ Date S ❑ SPECIAL PERMIT-Appro%ed by <br /> Character of Soil to Dept 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received reek# Amount Permit/ Invoice# Permit ID# <br /> ate Service Request# <br /> Code INFO By Remitted <br /> LL e ; , 6 r <br /> ONSITI:WAS II li'A-1FR Ill RMI I- <br /> 42-02-001 <br /> 11 1221X14 <br />