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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> a 30 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3M0 FL-STOCKTON CA 95202 - (209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953--7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS �0833 W W#jyUI (J-t'Put fd- CITY/ZIP TNOtPDl`/ 9S(P8(r <br /> 7' n <br /> CROSS STREET I — APN 00/- ver)-&Z- i PARCEL SIZE ac' Y <br /> 0 <br /> OWNERNAME rOhY MOOR t PHONE ([� <br /> OWNERADDRESS Jr1QZZ IA/ ' IAI6.'NUI C-ryv c 1) CITY/STATE/ZIP //'IPI-fv� CA 7 c s60p <br /> CONTRACTOR Q .�N P�`- PHONE yG -O O•L- <br /> CONTRACTOR ADDRESS32 A I.- CITY/STATE/ZIP P[i td/'1 <br /> LICENSE ❑C-42C-36 OTHER NUMBER 1 I EXPIRATION DATE <br /> TER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> fO PERCTEST 1 BUILDINGPERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADDITION ❑ 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 /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> O <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LME R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS OF LINES <br /> -T LENGTH OF LINES ` o© It <br /> DISTANCE TO NEAREST WELL /OO -t- tl FOUNDATION D It PROPERTY LINE it <br /> O 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 It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft C, <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft SNL <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY i <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. f <br /> MINIMUM 2d OUR ADV NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 66 D. <br /> SIGNED TITLE v ,JOC DATE <br /> , <br />