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I ti <br /> ONSITE WASTEAVATER TREATMENT SYSTEM PERMIT <br /> JOAQL'IN COUNT)ENVIRONMENTAL HEALTH DEPARTMENT 303 E WEBER A"E.3-FL-STOCKTON CA 95202 -(2(W 1420 <br /> MN-REFUNDABLE PERM T I, CALL(209)9��f1 FOR INSPEf'TIONS EXPIRES I YEAR FROM DAT :ED <br /> OR ADDRESS CITY/ZIP <br /> C,I L <br /> )SSSTREET f APV ) P.ARCELSIZE <br /> ). t.tA hqn <br /> �NER NA\IE PHONE_ <br /> )NYNER ADDRESS 1 CITY/STATE/ZIP <br /> TRACTOR l + _ 1PHON F. 7 7 <br /> �•4 }..iwr.J Ll\ �/' Yti!+' �� l l L Ll <br /> 66\TRACTOR.ADDRESS CITY/STATE/ZIP S� <br /> -I-- ❑C-12 ❑C-36 OTHER NUMBER E\PIRATION DATE <br /> .TER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> ..\PERC TEST(S) NUNISEP. LAND USE APPLICATION is <br /> TYPEOF\\'ORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATI\E - <br /> ❑ REPLACEMENT 0 DESTRUCTION 7 <br /> v <br /> iTALLATION\\'ILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER � <br /> NUMRER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TT PE/MFG CAPACITY gal #OF COMPARTMENTS <br /> -' GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> fi <br /> ` PKG TX PLANT DISTANCE TO NEAREST: \YELL ft FOUNDATION A. PROPERTY LINE H <br /> LIFTSTATION SIZE T\'PEOFPuatP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE fl <br /> FILTER BED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL A FOUNDATION ft PROPERTY LINE A <br /> MOUNDED WIDTH f2 LENGTH It DEPTH fI <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft <br /> SUMPS WIDTH A LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 11 PROPERTY LINE R <br /> DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> bY SEEPAGE PITS \\IDTH R LENGTH ft DEPTH Il <br /> DISTANCE TO NEAREST WELL f: FOUNDATION It PROPERTY LINE fl <br /> HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DON6'JN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAW'S AND RULES AND REGULATIONS OF SAN 5OAQUIN COUNTY. <br /> low M IMUAI HOUR DVANC OTICt REQUI RED FOR INSPECTIONS-P.LEASF.CALL(209)9?3-7697 <br /> / ])�' S\ <br /> O / <br /> I <br /> SIGNED�T= ; JI� .ii TITLE C/u - DATE <br /> " <br /> r-11TH ir� 1 <br /> E VI ON E T <br /> FA <br /> DEPARTMENT USE ONLY <br /> ..pplicalion Accepted By J, Date !'� Area Employee ID# �7 <br /> Final Inspection By Date -❑ SPECIAL PERMIT-Approved by ' <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character. <br /> :OMMENTS <br /> PE SC Received LG6eck#t' Amount Permit/ <br /> JNFD BY Cash Remitted Dale epic Re ues # Invoice# Permit ID <br /> qzj <br /> 2-0I-001 ONSITE WASTEWATER IRMIT <br /> b7/02 <br />