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4\SITE WASTEWATER TREATMENT SYWENI PtftA T�• <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HF.ALTII DFPARI'NIt:N'r 304 E WEBER AVE .3"'Fl.-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLF?PERMIT CALL(2091953-7697 FOR INSPE('T1ONS -- EXPIRES 1 YEAR FROM DATE ISSUED <br /> 1 � <br /> C, N '� — CITYlzII' s�Ir LCJZ�/.v S� <br /> JOB ADDRESS r <br /> 7 <br /> V� �7 <br /> CROSSSTREET �^l t rglq �"l�-A� APN_[-- O USG ---1 PAKC'EL$IZE p <br /> OWNER NAMEJ T�C.�Tt7 f� O -Sr C�U_�—GN -JGDoC— ._ _ PHONE <br /> OWNER ADDRESS /S M CITY)STATOZIP <br /> CONTRACTOR L E N , �/� _ PIIONF. <br /> CONTRACTOR ADDRESS t7 /r I y2,1 L� CITY/STATE/ZIP TLC Q S _ <br /> LICENSE. :1 C-42 U C-36 OTHER NLIVBER EXPIRATION DATE _— <br /> WATER TABLE DEPrH: ft GFOGRAPHICAL INFORMATION: Coordinates X -_ Y <br /> L PERU FEST(S) NUMBER LAND USE APPLICA1ION f* <br /> TYPF.OF WORK: ❑ NF.W INSTALLATION O REPMR/AUDITION ZI Em iNEER DEsmNED/ALTERNKFIVE <br /> ❑ REP1.ACE."IENT ❑ DESTRLCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF I.IVING UNITS: NUMBER OF BEDROOMS: NLMBEH OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE.-MFG CAPACIIY gal 4 OF COMPARTMENTS <br /> ❑ GREASE TRAP "n PEIMFG CAPACrrY gal 4 OF COMPARI'MENI'S <br /> ❑ PKG TX PLANT DISTANCE ToNFARFtiT: WELL ft FOUNDATION 11 PKOPEKIY LINE tl <br /> ❑ LIFT STATION SIZE TYPE OF PUMP LJ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 0 LEACH LINES 0 LEACHING CHAMBERS _ #OF LINES LLNGTH or LINE., ,_ 11 <br /> DISTANCF.TO NEAREST WELL R FOUNDATION_ Il PROPER IY LINE Il <br /> ❑ F1 IA ER BED WIDTH R LENGTH ft DEPTH _ ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION (t PROPERTY LINE ft <br /> 0 MOUNDED WIDTH ft LENGTH ft DEPTH _._ — tl <br /> DISTANCE TO NEAREST WELL tt FOlNDA1ION E`, PROPEKTY LINE A l <br /> O SUMPS WIDTH fl LENGTH _., _ ft DEPTH ft f <br /> DISTANCE TO NEAREST WELL, tl FOUNDAFION fl PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH_ Il <br /> DISTANCE TO NEAREST WELL ft FOUNDATION— _ _ __ _It PROPERTY LINE ft <br /> 0 SEEPAGE PITS WlnTll ft LENGTH _ ft 1)EP:H ft <br /> DISTANCE TO NEAREST WELL ft FOUNDA"rIOV 11 PROPERTY LINE ft <br /> 1 HEREBY ERTIFY THAT 1 HAVE:PREPA ED THIS APPLICATION AND TI IF.WORK W ILI,BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> SI' T LAW'S AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M MU. 4H IR ADVANCE NOTICE REQUIRED FOR INSPEC-(IONS-PLEASE.CALL(209)953-7697 <br /> SIGNED TITLE. DA'1-k <br /> _//(,Xv1 <br /> TLA t: <br /> � I <br /> i <br /> -7 <br /> M11 I <br /> aum-u ME <br /> - -- EN IH N EN AL <br /> -- -- 0' <br /> I <br /> DEPARTMENT USE,ONLY G�`1 <br /> Application Accepts Date 11(1104- Arca �t t Employee ID4 9 <br /> Final Inspection eS� _ Date / � ❑ SPECIAL PERMIT-Appioved by <br /> Character of Soil to th of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS 2f VC <br /> PE SC Received Checic/tJ Amount Date Permit/ Invoice 4 Permit IDN <br /> Code INFO By C—RiF Remitted Service Request 9 <br /> � 3 W <br /> 42-01-00 1 ON$ITr WAtiTFWATER PERMIT <br /> 12/2/02 <br />