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ONSITE WAST-WATER TREATMENT SYST"M PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH AnATMENT 304E WEBER A14 3`n FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT U4,--6r <br /> �,(, /,1 CALL(209)953-7697 FOR <br /> FOR INSPECTIONS -EEX}�PIIRES/1 YE/A]R FROM DATE ISSUED <br /> JOB ADDRESS /��/l� f9Vfi/6�r,, VfFLP�IG IJ K.O/�/J /� CITY/ZIP / KfiL�Y "1 3-7� L <br /> CROSSSTREET 4�rT L ./l•/yez-L`O//t/q �j A/!PN`� 14 Oma/-� O t�y /jPARCEL SIZE _9a � 0 <br /> OWNERNAME -SJ ` /JC(Z/V ir�✓7 6477-lel-le- /WalZG/1 PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR CHE.fNc y CONSUL%INCA PHONE '"if-&e3 <br /> / Q <br /> CONTRACTOR ADDRESS �- Q• Be r 37-7.4 <br /> - .4 CITY/STATE/ZIP -GrRL©Ck- CA- /q <br /> 5)301 <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: � O V ft GEOGRAPHICAL INFORMATION: Coordinates X Y - <br /> PERC TEST(S) NUMBER a LAND USE APPLICATION# A/Or ISSUED YET <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 /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL R FOUNDATION it PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ^ <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES R V' <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH fl DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH fl <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE fl <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> ❑ SEEPAGE PITS WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 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 /> M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)953"7697 <br /> SIGNED TITLE 4 we DATE <br /> 1. <br /> CC <br /> - DEPAR <br /> Application Accepted By —_ Area Employee ID# v/G� <br /> Final inspection By Date 2 Ig ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Wrth of 3 Ft: a Pit/Sump Soil Character: <br /> COMMENTS �.&Aj Ji aU- (LIGQ"002 <br /> �Y^ ) m �� � 2�' a -� 3 0�-' �.s"d.�,t,) lo•-�S �:os� 2.0"��� <br /> PE SC Received ee Amount ate Permit/ Invoice# Permit lD# <br /> Code INFO B ash Remitted Service Re uest# <br /> D o A4" <br /> 42-01-001 ONSITE WASTEWATER PERMIT <br /> 12!2/02 <br />