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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> 600 E MAIN STREET-STOCKTON CA 95202.(209)488-3420 <br /> SAN JOAQUIN COUNTY ENVIRONM�AL HEALTH DEPARTMENT ISSUED <br /> NON-REFUND CALL{ 953-7697 FOR INSPEC11 EXPIRE 1 Y <br /> JOB ADDRESS CrrY(Z <br /> CROSS STREET <br /> APN PARCEL SIZE <br /> ONE <br /> 1- <br /> OWNER NAME ire� <br /> OWNER ADDR.;'�qlj (/1 CITYISTAT IP <br /> CONTRACTOR !• `-' PHONE <br /> CONTRACTOR Aoouss 1N CITYIS7ATE(LIP I <br /> LICENSE Hv� --C36 OTHER A NUYBERI EXPIRATION DAVE �• <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST #` BUILDING PERMIT# LAND USE APPLICATKk1# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED IALTERNATNE <br /> REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ._! OTHER <br /> NUMBER OF LmNG UNITS: µUNDER OF BEDROOMS: NUMBER OF Ef1PLOYEES: <br /> ❑ SEPTIC TANK TYPEJMFG_ CAPACrrY 9z1 #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPI-JMFG CAPACITY - pal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft,,FOUNDATION _ ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> f (, <br /> LEACH LINES K LEACHING CFIAMBER`, #OF UNES LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL 5 1 n FOUNDArfON ft PROPERTY LINE ft <br /> ❑ FILTER BED wIDTH ft LENGTH ft DEPTH —n <br /> DISTANCE TO NEAREST WELL_ ft FOUNDATION--ft PROPERTY LINE ft <br /> ❑ MOUNDED Worm n LENGTH ft DEPTH It <br /> OMTANCE TO NEAREST WELL ft FOUNDATION. n PROPERTY LINE ft <br /> SUMPS WIDTHnTMi- _� `r3EPTH ft <br /> DISTANCE TO NEAREST WELL h fOUNDAT'ON ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNOATION ft PROPERTYLINE ft <br /> O SEEPAGE PITS NUNBER WIDTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br /> %t�t" <br /> STATE LAWS AND RULES AND REGULAnON$OF SAN JOAOUIN COUNTYr REQUI►<EDFORtt953-7�TAin[,I'SVll DAT ( iyJ <br /> 1 <br /> r <br /> _II <br /> I <br /> I <br /> I ( SAN JO 0 IN N <br /> E 0 M <br /> I <br /> ITIlili I <br /> D ARTMENT E ON <br /> Application ACCepteDate Area <br /> Employee 10# <br /> Final kispection Date SPECIAL PERMIT-Approved by_ <br /> Character of SO;i to D of 3 Ft: P jmp Solt Character: <br /> COMMENTS L��i� <br /> PE SC Received CheW1'J Amaunt In,, I-# Permit IDS <br /> Code [we Remttted ' Date Mist <br /> I <br /> 42-0' I Moto <br /> ONSITE WASTEWATER TRTWT SYSTEM PERMIT <br /> 1 Df"7 <br />