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ON51 IE WA5I EWA I LK I KLA I MLN I STS I LM rtMIVII I <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 96202.(209)46$-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 7 YEAR FROM DATE ISSUED <br /> JOBADDRESS I`F InZ 1V E_. WIL.Dwigro ) Ab Cm/zjp SIfOG11-bri 115"Z•15- <br /> a <br /> CRoas STREET APIN 32.0 %mP • �' <br /> • OWNERNAME ST{�NL�'Q-� yE'�sf�GI2.�t$ES PHONE 5,71- ZIb- 1234 <br /> WN <br /> OER ADDRESS I I❑ YL't�X^� /L- >t t+ C 1. CM/STATEZP G' Q L'D P",V t F-! CA 9 S(P�D <br /> CONTRACTOR LIJEOFt�L GE OENY)R-0NN1EN7/Cl PHONE 3(>fi-03fiS <br /> CONTRACTORADDRESS `�� W> OAK- ST• CITY/STATIMI CA `p <br /> S Z4 <br /> LICENSE QC42 QC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERCTEST # BUILDING PERMIT# LAND USE APPLICATION# -1(pO020 <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEERDESIGNED/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 TYFE/MFG CAPACm gal #OFCOMPARTMENTS <br /> Cl GREASETRAP TYPE/MFG CAPACm gal #OFCOMPARTMENTS <br /> DISTANCETONEAREsT: WELL ft FOUNDATION It PROpERTYLINE ft <br /> ❑ LIFTSTATION SRP TYPE OF PUMP ❑ PKGTXPLANT Cl SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTHOFLINES ft <br /> DBTANCE TO NEAREST WELLIt FOUNDATION ft PROPERTY UNE ft <br /> ❑ FILTER BED WIDTH IN LENGTH ft DEPTH '0.su�yy_ <br /> DBTmcE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 't� BgYI <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH •k c.p�+g,.,�, <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYUNE� It <br /> El <br /> B <br /> ElSUMPS WIDTH ft LENGTH ft DEPTH ^R 1'7 <br /> DaiTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE It <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH "•j <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE AIh� QUN` <br /> ❑ SEEPAGE PITS NUMBER WIDTH fl DEPTH m P NTgL 'y <br /> • DnrTANCETONEAREST WELL R FOUNDATION ft PROPERTY LINE It �Rrh'ENT <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCE$, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI(N/j/Mg�M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTION$-PLEASE CALL(209)SS3-7697 <br /> SIGNED TIME. GONSV LTnNT DATE <br /> �i:w'awr a evXo w <br /> w>e' <br /> a BIrn\ m r A S 9 - <br /> a <br /> S ¢ 4 <br /> > p <br /> a e O C- $ <br /> s s s 9 a <br /> m $Y <br /> F tl � P NJ i <br /> DEPARTMENT <br /> Application Accepted BX Data Area EmployeelD# -l• <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil W Depth of 3 FC PitlSump Solt Character. <br /> COMMENTS <br /> • PE SC- <br /> he Amount PetmiU <br /> Code INFO Remitted Data Service Re uest# Invoice# Pormit lD# <br /> Z7iZ L / v ! l A940-7-712-2- <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />