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f_ - •' _ ONSITE WASTEV1- 1�K 1 K1�A 11V1L"111 1 r 0 1�lri A JLJAN.,v.x A ,JOAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DF.,I �MENT 304 E WEBER_ AV FL-STOCKTON CA 952g2,.-,-P0" 8�3�2 y ``NON-REFUNDABLE PERMIT. ALL(209)953-7697 FOR INSPECTION S �XP1RE5 1 YEAR FRO'M17 i"I`' "19'SI�F�H� Y JOBADDRESS D CITYIZIP CROSS STREET APN O I -/30 /-7 PARCEL Z o O 09 OWNER NAME PHONE OWNER ADDRESSCITYISTATEIZIP i PHONE CONTRACTOR CONTRACT ADDRESS CITYISTATEIZIP LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ` ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION E] REPAIRIADDITION ❑ ENCiNEERDESICNEpIALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION - - [INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIALOTHERBER OF LIVING UNITS: NUMBER OF BEDROOMS: _ NUMBER OF EMPLOYEES: SEPTIC TANK T1 PEiMFG /70 1'0-e _ CAPACITY V gal #OFCOMPARTMENTS cT CREASE TRAP TYP0MF6 CAPACITY gal #OF COMPARTMENTS © PKG TX PLANT --DISTARCE TO NEAREST: WELL - -� ft FOUNDATION ft PROPERTY LINE - ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) /14 LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ( ft �. DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 0 FILTER BED WIDTH ft LENGTH ft DEPTH DISTANCE7. TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft r Y+` ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPL-RTY INE ft 129,1 SUMPS WIDTH R LENGTH . ft DEPTH ft f DISTANCE TO NEAREST WELL FOUNDATION 73- ft PROPERTY LINE / tt ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DisTANCF,,TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ` SEEPAGE PITS WIp ft LENGTH ft DEPTH ft � tt .DISTANCE TO NEAREST WELL FO DATION ft PROPERTY LINE I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, IMUM I4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE' ©' �/L DATE C O 1� i IN qI 4 r no . 1 Ij IO finish f8 A."p1 c apt ! t an 18"rviil re 'it an p IT S o ax u LI E DEPARTMENT U ONL Application Accepted B Date Area Employee iD# Q rf Date ❑ SPECIAL PERMIT-Approved by Final IHspection By Character of Soil to De hof 3 Ft: Pit/ ump oil Character- Comm ENTS haracter:COMMENTS 0 00 t k Com, Check#/ PE SC RAmount Date Permit/ Invoice# Per eceived mit ID# Code INFO a as Remitted Service Re ucst# - 120 I, _D 1 b OVA 42-01-0 1 i �.� �y � �LO�S/rtf� 1A43LG.F7 �y Cu d STEWATEftPERM[T 12I2/02�ya -� zo�? 7 ��: Yv�tY[ r�.�ic r�zi{p 4s'"•a �ty' z - 3/S/a�, '�Cla�rr��J