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4 ONSITE WAST1 'ATER TREATMENT SYSTI+sPERMIT ' <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL.HEALTH DEPARTMENT 304 E WEBER AVE -3"0 FL—STOCKTON CA 95202 - (209)468-3420 <br /> i <br /> —REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZIP LA <br /> CROSS STREET _7' " _4, -APN VCJ r '7 L� • PARCEL S[ZE V I <br /> OWNER NAME .�'.�'�.�z�j/) �-- PHONE <br /> ONVNI:RADDRES` � �JS / Gk ,�•%� CITY/STATE:/ZIP <br /> CONTRACTOR PHONE: ' <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> M <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT,# LAND USE APPLICATION# G'Y` <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL l OTHER <br /> NUMBER OF LIVING UNIT'S: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> © SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPL/MFG CAPACITY gal 9 OF COMPARTMENTS <br /> ❑ 1'K(;TX PLANT DIST'ANCE'ro NE:AUE:1r: Wi:LL _ Il L"0UNDAII0N 1l PRO PER'I'Y LINE 11 {- <br /> ❑ LIFT STATION SIZE. TYPE OF 1'uNil, ❑ SAND OIL.SEPARATOR(ENCLOSED SYKrENt) J <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL - ft FOUNDATION ft PROPERTY LINE ft ) <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> .j <br /> ❑ MOUNDED WIDTH ft LGNGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL. ft FOUNDATION ft PROPERTY LINE ft , <br /> • SUMPS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL (t FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DWI'ANCE:TO NEAREST WELL R FOUNDATION it PROPERTY LINE fi <br /> ❑ SEEPAGE PITS NUMBER WIDTH �, fl DEPTH ft r1 <br /> DISTANCE:TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE- ft <br /> i <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES TATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> iN11Nl <br /> 72�4OU D AINCE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697LSIGNED - ' j I ) - I I-_ -I—� L <br /> I 1 i I T_ <br /> rrJj--- _u14;./..t2u — --- _ t <br /> _ I Ga _ .. 1 <br /> _ <br /> _....,... i <br /> t <br /> I I, <br /> - j.-._.I I i. I �J - / • ... LEC_.. �__, I:S�f'i1.. ._._._r Qa._.-�_,._T r € t .E <br /> i <br /> [ i ; <br /> '- -___ ' ' -•--'�� -t-'- --i._._.� i._.._._�,.. { � � <br /> :... II _ <br /> I <br /> 'tt 4 <br /> Ut f <br /> .. k� �(.. i j i {� .Lh-ti+.�-. a�y?•�LX'�,r!S.-'---- -'-Q% �._._._1. -��-1K✓ - --}-- <br /> f <br /> lye f <br /> f 1 <br /> I <br /> f <br /> I <br /> 10 <br /> /� MFPARTMENT USE ONLIV Q - <br /> AIIIIlicatiuB Accepted By/ /( U Date Arab ^1� I:ruployee:IDyP� pq L <br /> Final Inspection By, �,t Date ❑ SPECIAL PERMIT-Approved by // <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS rrly,�, ��1' _ �? ,c ,s ', "f; _'p,' <br /> �� <br /> PE SC Received Ch Amount at Permit/ Im tce� �y r <br /> Code into B Cash Remitted Service Re ucst# c��C� ✓• � G�� <br /> 2-112-001 ( ONSITE WAST ]NATER PERMIT <br />