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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JoAotum COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)408-3426 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> Jos ADDRESS <br /> CFTYIZI <br /> CROSS STREET <br /> APN PARCEL SIZE <br /> OWNER NAME PHONE <br /> OWNER ADDRESS CrrWSTATFJZM <br /> CONTRACTOR IV' -PHONE <br /> CONTRACTOR ADDRESS CITYISTATEIZIP <br /> LICENSE [SC-42 UC-36 OTHER NUMBER EXPIRATION DATE 55 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# 1 1 <br /> TYPE OF WORK: 1i NEW INSTALLATION D REPALRYADOiTEON 0 ENGINEER DESIGNED IALTERNATFn <br /> D REPLACEMENT 0 OUT-OF-SERVICE SEPTIC SYSTEM 0 DEmucnoN <br /> INSTALLATION WILL SERVE: D RESIDENCE 0 COMMERCIAL C1 OTHER <br /> NUMBER OF Lwa UNITS-. NUMBER OF BEoROOMS,. NUMBER OF EMPLOYEES: <br /> Q SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> (3 GREASE TRAP TYPEtMF;G CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE It <br /> 13 LIFT STATION SIZE_TYPE OF PUMP 13 PKGTXPLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 13 LEACH LINES U LEACHING CHAMBERS #oFLINES _ LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE <br /> C) FILTER BED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> C1 MOUNDED WIDTH It LENGTH It DEPTH ft <br /> K <br /> DISTANCE To NEAREST WELL_ft FOUNDATION ft PROPERTY LINE f, fi <br /> 13 sumps Wicrrm ft LENGTH ft DEPTH <br /> DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTYLINE <br /> 13 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION It PROPERTY LINE <br /> 13--SEEPAGEPFTS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL It FOUNDATION ft P-FiOPFRTY LINE ft <br /> E HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MIi IMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)963-769T <br /> SIGNED' A tom. TITLE T <br /> DATE 2 <br /> I I J <br /> PAYmr=P T <br /> :11:qEjPV E <br /> U I <br /> T <br /> I j I SA 4 J AbUl UH EAR <br /> 47' <br /> �0 <br /> DEPARTMEN E <br /> T�.U?��N L Y <br /> D., Am. <br /> Application Accepted By Employee ID# '5 <br /> Final InspecUon t3y Date D SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Plt/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received hecW Amount Permit) Invoice# Permit too <br /> Code INFO BY ars Remitted Date Service Request# <br /> 1�4 7 r- 5liz 0o 6-0 <br /> 42-01 ONSITEWAS7EWA7SRTRTMNT SYSTEM PERMIT <br /> 6t26109 <br />