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ONSITE WASIWATER TREATMENT SYST, , PERMIT <br /> SAN JOAQUI)COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3""FL-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFIi.NDARLE PERMIT CA1,1, 209 953-7697 FOR INSPECTIONS EX"OnPIRES 1 YEAR FROM DATE ISSUED <br /> L�iY t2e, t'rn/Glr t XK , <br /> [CROSS STRF:r:TAPN O I Jr �20 '� � PAK('r ,SIZE S o <br /> NNER NAME /t!O /macyY1 Gt r2VNF.R ADDKF:SS ���� ��/S/�N t�V CITY/STATv/'LIPS%/ /Gvf enty <br /> N'I'R,VI"1'OK <br /> PHONE <br /> CONTRACTOR ADDRESS <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER <br /> EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFOR.NIATION: Coordinates X y <br /> ❑ PERC TEST # E4— p BUILDING PERMIT# LAND USE APPLICATION# <br /> TI'PE OF WORK: NENN INSTALLATION ❑ REPAIWADDITION ❑ ENGINEER DESIGNED/ALTERNATIVELI REPLACEMENT L] DESTRUCTION <br /> INSTALLATION WILL SERVE: /�'RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UMTS: / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ® i <br /> - <br /> Sr� <br /> I?PTIC"TANK TvPL:/Mr•G .__ Cnrn("rly _ 2-_OOU gal #OPCOMPARTMIiNTS <br /> ❑ GREASE TRAP iY1,111VII'(1 CAPACITY gal #OFCOMPARTMENTS <br /> ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LINE R ` <br /> ❑ LIFT STA'T'ION STLE: TYPE OF PumP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> s <br /> I, C <br /> LEACII LINES ❑ LEACHING CHAMBERS #or LINES (I fj <br /> _ LENGTH OF LINTS <br /> DISTANCE TO NEAREST WELL it FOUNDATION S It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH f[ DEPTH tt <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH ft DEPTH ft r <br /> DISTANCE TO NEAREST WELL / qo ft FOUNDATION 70 ft PROPERTY LINE <br /> SUMPS WIDTH ft LENGTH �� tl DEPTH R V <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISI'ANCE'ro NEAREST WELL_ ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH „ ft DEPTH ft <br /> DISTANCE To NEAREST WFLI fl FOUNDATION ft PROPERTY LINE ft <br /> I HI•:KISIiI'CEK'I'II l'"1'11A"I'I"AVE PREPARED THIS APPLICATION ANDTHE WORK NVILI.BE DONE:IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,ST'A'TE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> ' D / M!i IMLM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE:CALL(209)953-7697 <br /> SIGNED .4�J/`�/t j���/Y �^ TITLE Q!�zl a tz DATE <br /> l <br /> u � <br /> i <br /> i " <br /> ix�- d <br /> ,- f <br /> Irr to h <br /> l I <br /> 4P jUUj <br /> S <br /> L/ G 5 N A T L <br /> D A i <br /> DEPARTMENT USE ONLY L/ <br /> Application Accepted By Date /21 " Area Employee ID# <br /> Final Inspection 13,ahof <br /> f a:�'J D to �e 2� ❑ SPECIAL PE MIT-Approv,�d by / <br /> Character of Soil to Pit/Sump Soil Character: <br /> COMMENTS g F7 <br /> w-._ l vCa ham:_ L;.v r <br /> i T� tt-'l=l.t_ �,�--(7..)rJ i= �'i r)� O�Li..�•E��_. it W ✓r-,..; �.v r��. <br /> Ll < �i� 1'' 2� —r Mri-1/ AIT s F'7- O71-1 IF 6 <br /> PE SC Received C eck# Amount <br /> a �O _ I Permit-iD# L."C f 1"-•� <br /> Code INFO By sh Remitted Service Re uest# <br /> f1oc £ <br /> TE WAS <br /> Tj W A R P�I� <br /> 42-02 001 <br /> 1 <br />