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OD <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3"FT.-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 951-7697 FOR INSPECTIONS �EyXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS U 'Trl E. w // JCITY21P LIgIJt��/ -r �j Z 3 <br /> CROSS STREET H,w*1 2F; APN JN —300-0/0 PARCEL SIZE <br /> OWNERNAME w 9�� RE&Il PHONE i <br /> OWNERADDRESS b l Ul/e_T� Pj�/ CITY/STATE/ZIP SO <br /> CONTRACTOR P110NL C63/ 41/0 C;115k <br /> CONTMCTORADDRES5 CITY/STATE/ZIP <br /> LICENSE ❑C-02 0C-36 OTHER NUMBER ExPIRATIONDATE <br /> WATERTABLEDEPTH: ft GEOCHU PHICALINFORMATION: CBOrdimitee X Y <br /> ❑ PERCTEST # BUILDINGPERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ® NEWINSTALLATION ❑ REPAIWADDITION ❑ ENGINEERDESIGNED/ALTERNATIVE <br /> '❑` REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: �RRSIDENCE O COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS! NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> I SEPTICTANK TYPE/MFG CAPACITY IGOy gal #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gel #OF COMPARTMENTS <br /> ❑ PEG TX PLANT DISTANCETONEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLL'OSE)SYSIEM) W <br /> �1 LEACH LINES EJ LEACHING CHAMBERS #OFLINES Z LENGTH OF LINES h� ft <br /> r <br /> DISTANCE TO NEAREST WELL R FOUNDATbN R PROPERTY LINE ft ,J <br /> ❑ FILTER BED WIDTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft T <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION Fl PROPERTY LINE ft <br /> Cl SUMPS Wmix R LENGTH ft DEPTH it Y <br /> DISTANCETONEAREST WELL R FOUNDATION R PROPERTY LINE R R <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH R <br /> NJ DISTANCE TONEAREST WELLL /eft FOUNDATION R PROPERTYLI(N�E ft <br /> YL SEEPAGE PITS NUMBERy DZUR J._S R DEPTH �S, R <br /> DISTANCE TONEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN,JOAQUIN COUNTY <br /> ORDINANCES.STATE I A.sun on.o�.....•.••.....---- <br /> SIGNED (. WA 3 7"ZO —06 <br /> 7R' i <br /> (ia Ff <br /> y I I t C <br /> � <br /> i I <br /> F[ � <br /> k ' <br /> IY' <br /> '�YyplicetioDAccepted - --- Dale —( 20 Ob Am Employee IDS <br /> Final lnspectionB ,[r. - Date 1���/L• 13 SPECIAL PERMIT-Appmvedby <br /> Chaneter of Soil to th oT3 Ft: Pit/Sump Soil Character. <br /> COMMENTS ArEw SRT GF �Et ORJJ dL-75-e3' /iCf•: <. 37e-L !<z�z�,371i' ,� <br /> �Zi2- S�.t/k r1c S 7 .�s7r3J<r. rr>. <br /> > <br /> PE SC R..I,, Amount D tB Permltl InvDiceq Permit lDp <br /> Code INFO B Csa Remitted Service Re ueet# <br /> 42.11 1(-7 <br />