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ONSITE WASTITWATER TREATMENT SYSTFM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH D.,,,,,_TMENT 304 E WEBER A 1,.3""FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209,)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUElp <br /> JOB ADDRESS �� CITY/ZIP <br /> '� C PARCEL SIZE �`✓r CJ <br /> CROSS STREET ;;/I/t//N� N`� APN <br /> 0 <br /> OWNER NAME A PHONE /SSI/-� 4/ j z n <br /> OWNER ADDRESS �� 6T 37 CITY/STATE/ZIP <br /> CONTRACTOR A2 2 /{z,-1 '4�f1/�JJ fJ � } - PHONE is <br /> CONTRACTOR ADDRESS �/�/� �(J1/ 1"! CITY/STATE/ZIP <br /> LICENSE AC-42 ❑C-36 OTHER NUMBER ESPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y - <br /> L <br /> ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> > l <br /> SEPTIC TANK TYPE/MFG Z CAPACITY �/,�jo/)- 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 ❑ SAND OIL SEPARATOR(ENCLOSEDSYSTEM) <br /> XLEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES �✓ ft <br /> � a <br /> DISTANCE TO NEAREST WELL ft FOUNDATION tt PROPERTYLINE 1] ft <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 13 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE f[ <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <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 2 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION �i ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTYORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 UR ADV NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE DATE <br /> I �< <br /> AN O T L <br /> ie <br /> DEPARTMENT UYE O Y 22 <br /> Application Accept 1->fi� Date }(. J Area Employee ID# �✓ y/I I <br /> Final Inspection y Date ❑ SPECIAL PERN11T- proved by <br /> Character of Soil t t of Ft: Pit/Sump Soil Character: / <br /> COMMENTS <br /> "l.��. ��'�'.f.,c.; �_. J•�`�, ;,/ J Pv r/.'k.A c'; ,.-C: ��, ��.` �/�n"�",vi 711D# �-4_71,1 mit �4 <br /> PE SC Received heck Amount Permit/Code INFO By ash Remitted Date Service Re uest# Invoice# Per <br /> L r' <br /> 42.01-001 <br /> 12/2/02 ONSITE WAS"I"EWA TER PERMIT <br />