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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT r— <br /> N OAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3"FL-STOCKTON CA 9F fj65l)4h63I20 <br /> *JN-REFUNDABLE PERMIT CALL(2vr �..�3-7697 FOR INSPECTIONS EXPIRES I YEAR R ATE ISSUED <br /> to <br /> JOBADDRESS J[4209Sr A) uk/ sA /_JOFVF CITYJZIrJl'e0„.L' 192,41 <br /> .DES STREET ^� APN o5-91-110-40PARCELSIZE S" � 4LC.rfS S <br /> rq/NCR NAME TNDFIZ IDYy127 IC PHONE <br /> OWNERADDREES CITY/STATWLIr <br /> INTRACTOR 11re/A%A/ ,(�f�T, G�r/��/ PHONE <br /> ` 3G`/-Soz7 <br /> LTINTRACTORADDRESS E /1//fK-L'�� F Vc clTv/$TATIJZIe /�- <br /> LICENSE giC42 C)C-36 OTHER NUMBER [/S 57 EXPIRATION DATE <br /> ATENTABLEDErrit: H GEOGRAPHICALINFORMATION: Coordinate X V <br /> Iw PERC TEST(S) NUMBER LAND USE APPLICATION N <br /> ME OF WORK: ❑ NEWINSTALWTION ❑ REPAIR/ADDMON O ENGINEERDMIGNED/ALTERNATIVE <br /> REPLACEMENT DESTRUCTION O(.O TJA- 14 <br /> JSTALLATION WILL SERVE: 'RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> Bt< NUMBER OF LIVING UNITS: J / NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> 14SEPTIC TANK TVPE/MFG SO/2^/ CAPACTTT Eel NOFCOMPARTMENTS 3 <br /> GREASE TRAP TYPEIMFO > CAPACITY E°I N OFCOMPARTMENTS <br /> �1 PKG TX PLANT DISTANCETONEARPBT: WELL /O A It FOUNDATION��i ft PROPERTY LINE / / R <br /> ❑ LIFT STATION SIZE TYPE OF PUMe ❑ SAND OIL SEPARATOR(ENCLOSEDSYETEM) <br /> 1, LEACH LINES LI LEACHING CHAMBERS NOF LINES y LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL StO H FOUNDATION Sibr fl PROPERTY LINE SC/ R <br /> ❑ FILTER BED WlpTll It LENGIH It DEPTH It <br /> DISTANCEMNEAREST WELL ft FOUNDAMN ft PROPERTY LINE It N <br /> 1 MOUNDED WmTH ft LENGTH It DEPTH ft C <br /> y DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It 4) <br /> ❑ SUMPS WmTH R LENGTH It DEPTH It DO <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It (L` <br /> 2 DISPOSAL PONDS W.IH R LENGTH It DEPTH It C <br /> DISTANCETONEARPST WELL ft FOUNDATION ft PROPERTY LINE R <br /> SEEPAGE PITS WIDTH 7(-� ft IEHDTH ft DEPTH -. - It h <br /> DISrANCETONEAREBT WELL / It FOUNDATION /AS ft PROPERTY LINE R ft y <br /> HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, r <br /> BB,, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. T <br /> MINIMUM H HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONN/S__-PLEASE CALL(209)953-7697 <br /> :IGNED TITLE�avJ$Wp.'V' DATE <br /> D 2 <br /> R <br /> OA UI U <br /> DEPARTMENT Sr N V <br /> Applfutbn Aoupted6 Date !� 3 D Arca a/ Employe IDN L)I'f? <br /> Final lnFpatian Date ❑ SPECIAL PERMIT-Appmved by. <br /> Chancier of Soli to Nplh of 3 PC PIUSu p Soil Chander: <br /> —COMMENTS <br /> PE SC RecNved Amoual PerMU IRvoluN Permit IM <br /> Code INFO B eh Remitted D°b ServluR ue[p <br /> 42- it) its- <br /> h' <br /> fsh' 8241-001 ONSRE WASTEWATER PERMD <br /> ILLD2 <br />