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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 306E WEBER AVE-3Y°FL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRE55 1 1 t '� 1 l- CfYmp <br /> ` CROSS STREET ��'. APN (' 1 1 PARCELSM <br /> OWNER NAME � '- » +' � PHONE <br /> OWNERADDRFSS T Z 'L �j CiTY/STATE/TAP . <br /> CONTRACTOR <br /> t• ._.1.. r 1 PHONE <br /> Coon BACTORADDRESS "" CITY/STwTFILIP - - <br /> i <br /> L i LICENSE ❑442 ❑C-36 OTHER L NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: CROPINGAWE X Y <br /> H PERC TEST # i 1 1 BUILDINGPERMIT# LAND USE APPLICATION# - <br /> TYPEOFWORK: ❑ NEWINSTALI.ATION ❑ REPAnVADDITION ❑ ENCINEERDESIGNED/ALTERNATIVE <br /> L O REPLACEMENT ❑ DESTRUCPION <br /> �I INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL O Oraea <br /> NUMBER OF LIVING UNITS: NUMBEROFBEDROOMB: NUMBEROFEMPLOYEES: <br /> ( ❑ SEPTIC TANK TVPEAVIM CAPACITY Bol It OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gel #OFCOMPARTMENTS <br /> ❑ PKC TX PLANT DISfANCETYI NEAREST: WELL R FOUNDATION ft PROPERTY LME it <br /> ❑ LEFT STATION SIZE TVPEOFPUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES A <br /> DISrANCETONEAREST WELL it FOUNDATION it PROPERTY LINE R <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTYLINE it <br /> ❑ MOUNDED Wt. - A LENGTH ft DEPTH A <br /> DISTANCETONEANEST WELL R FOUNDATION A PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH! A <br /> DISTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> r ❑ DISPOSAL PONDS WmiH ft LENGTH A DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LME R <br /> ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH ft <br /> _ DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LME R <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> NI IN I M UM 24 HOU R ADVANCE NOTICE REQU I RED FOR I NSPECTI ONS-PLEASE CALL(209)953]69]/ <br /> " SIGNED . TITLE %' Jll e ! I DATE P'lI'o�,•�. <br /> T <br /> I Zanl - J <br /> r. T <br /> SITE PLANN.1 GUT <br /> IR N AE frAl <br /> ME <br /> ,..f/ f DEPARTMENT US ONVV ` _ <br /> Application Accepted By V^ I' ""'^" DEE I / 1-, ATu Employee JUN .:.•�� :J <br /> 6. Character <br /> limit d.n By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 ED PIUSump Sail clo rocter. <br /> COMMENTS <br /> i <br /> PE EC R"E'Vo" CAec� Amount Doh Po.Iv Invoice# Permit lDM <br /> Code INPO B Cash Remitted Service ua11 <br /> V <br /> 42-02-No ONSITE WASTEWATER PERMIT <br /> 1282/20/3 <br />