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D <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> USAN JOAQUIN COUNrY ENVIRONMENTAL HEALTH DF..PARTMENT 304 E WEBERAVF -3"FL-STOCKTON CA 95242 - (209)465-3420 <br /> N\ON-REFUNDABLE PERMIT CALL(209/953 7697 FOR INS CTIONS EXPIRES 1 YEAR FROM DATE ISSUEYi <br /> JOB ADDRESS _ �j�/7 L Ctrs,/ZIP y..rr� n..! � - <br /> CROSS STREET ny -�pj� .1 <br /> /j` __ APN /Q -_-- PARCEL SIZE <br /> }} L v <br /> OWNER Nf:ME �� /� '� 1 d•��' A J_q h PHONE <br /> OWNER ADDRESS fff J� i T C)TYISTATFJZIP <br /> CONTRACtTM - .�f�r PHONE C --r--W! <br /> CONTRACTOR ADDA;SS�•5(J Y /t 1 Q,e <br /> CITY/SrATUZKP <br /> ,O LICENSE ❑C<V2 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: _ tj GEOGRAPHICAL INFORMATION: Coordinates X +( <br /> PERC TEST it+ BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: U NEW INSTALLATIONWEREPAIPJADWrION ❑ ENGINEER 11}S"KDIALTERNATIVL <br /> ❑ REPLACEMENT ❑ DESITmUCTION <br /> INSTALLATION WILL SERVE: 10 RESIDENCE ❑ COMMERCIAL73�OiHER_�✓ 7yy� <br /> NUMBER OF LIVING UNITS: __1 NUMBER OF BEDROOMS: .f <br /> NUMBER OF EMPI.oYvs: <br /> 0 SEPTICTANK TYPEIMFG_y,C6hKy CAPACITY 981 #0FCOMPARTMENTS <br /> ❑ <br /> GREASY,TRAP lYPEWFc CAPACITY pi #OF COMPARTMENTS <br /> ❑ PKC TC PLANT DISTANCE TO NEAR,:ST: WELL ft FOUNDATION ft PROPERTY LME <br /> _ft <br /> G] LIFT STATION Svc TYPE OF PUMP CJ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 0 LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OE LINES <br /> R <br /> DIATANrf.TD♦NEAREST wrLL R FOUNDATION ft PROPERTY LME R <br /> 0 FILTER BED WIDTH IZ� R 1F-NGTH S ft DEPTH f <br /> r� R <br /> D DISTANCE TO NEAREST WELL Sn ` ft F'DUNDATION_j D R PROPERTY LME f 0, P R <br /> ❑ MOUNDED WIDTH. R LENGTH ti DEPTH <br /> R <br /> D DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME tj <br /> ❑ SUMPS H'TDTx. fl LENGTI ft DEPT <br /> DISTANCE TO NEAREST W1'IT, ft fWNDATN?N ft PROPERTY LME R ' <br /> O DISPOSAL PONDS WmTR ft LENGTH, ft DEPTH <br /> R <br /> DLS•1'ANCE TO NEAREST WELL- _ft FOUNPATION ft PROPERTY LINE Ij <br /> ❑ SEEPAGE PITS Numm W.... <br /> ft DEPTH R rN <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft <br /> 1 HEREBY CF.RTFY THAT i HAVE PREPARED THIS APPLICATION AND THE WORK(WILL,BR DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND ROLES AND REGULATIONS OF SAN]oAQUtN COUNTY, <br /> MINIMUM ZA HOUR ADVANCE NOTICE REQUI XED FOR INSPECTIONS-PLEA-%E CALL(209)9 3-769? <br /> �' tl SIGNED <br /> • - -�.._ DATE <br /> �q <br /> 7-1-T k <br /> S s �t # N L'• a i f <br /> i - • yiJ�LE- - 7 <br /> %x <br /> q '{� Z t` <br /> rr <br /> - 6 <br /> v <br /> T o <br /> T <br /> APPUC0608 Aeceptul 13 i.`I <br /> Employee mployee ID6t <br /> Final Inspactbo Ry Date 1 � SPECIAL PERMIT- <br /> Character o(Slstl to of 3 t � Approved b)'_ <br /> PIUSUMP Sail Character. <br /> COMMEWS rs ys,Zol Te4w rA�4— c %A,I?( J2x zo Al <br /> PF. SC B <br /> Code KxFn Recurved C ec Amount <br /> PerntlU alul Remitted Service ueat# tmolee k Pernat IDN <br /> U� <br /> 42.02.001 <br /> 12' :DU3 ONSITE WASTEWATER PERMIT <br />