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f <br /> s <br /> a <br /> NSITEWASTEWA..-ER TREATNI ENT SYSTEMA PERMIT <br /> SAN JOA2UIN COUNTY ENVIRONMENTAL_FIEALTI-I DEPARTMENT 9 868 E.FIA7_ELTON AVENUE-STOCKTON CA 95205-(2.09)468-3420 <br /> NON, <br /> -REFUNDABLE PERMIT _ CAL (299)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS f CITY/ZIP <br /> CROSS STREET _ ��I c^►OCC{� APN o – PARCEL SIZE • � d <br /> OWNER NAME 00l-c 4 jk 1,-eA F $261- PHONE1 <br /> OWNER ADDRESS �IZS l"tt�Lt e/«Becs� CITY/STATE/ZIP ���f n pelf 7 V <br /> CONTRACTOR (%i&� &e- -Qar(/e`C.C, PHONE anc) Li sr ;tm <br /> CONTRACTOR ADDRESS PO eclX (v50 CITY/STATE/ZIP 75-33(a <br /> LICENSE LII-IC-42 FI17C-36 OTHER--& NUMBER -T EXPIRATION DATE--6*ua-p <br /> 'l/ <br /> YVATEP.TABLE DEPTH: V it GEOGRAPHICAL INFORMATION: Coordinates Y Y <br /> ❑ PERC TEST # BUILDING PERMIT )...AND USE APPLICATION# <br /> TYPE_OF WORK: NEW INSTALLATION -. REPAIR/ADDITION 1.1 ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEME=NT ] OUT-OF-SERVICE SEPTIC SYSTEM I<ESTRUCTION <br /> INSTALLATION WILL SERVE: ESIDENCE 1 1 COMMERCIAL FI OTHER <br /> NUMBER OF LIVING UNITS:— 1 NUMBER OF BEDROOMS: f NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MPC; /' (/- CAPACITY ' `� qal #OF COMPARTMENTS <br /> r GREASE_TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION fl PROPERTY LINE ft <br /> G' LIFT STATION SIZE TYPE OF PUMP 13 PKG TX PLANT L) SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES '-I LEACHING CHAMBERS it of LIrIus LENGTFI OF LINES yep ft <br /> DISTANCE TO NEAREST WELL J,_ O&I ft I-OUNDArION 3ZS' ft PROPERTY LINE 46 ft <br /> FILTER BED WIDTH ft I-FNOTvi it DEPTH It <br /> DISTANCE TO NEAREST WELL fl FOUNDATION It PROPERTY LINE It <br /> [T MOUNDED WIDTH it LLNGTI-I It DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft <br /> L^ Sumps WIDTH It LENGTH ft DEPTH It <br /> DISTANCE.TO NEAREST WELL It FOUNDAUON -ft PROPERTY LINE It <br /> Ix DISPOSAL_PONDS WIDTH It LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE _ 'It <br /> 4I-/SEEPAGE PITS NUMBER et- WIDTH It It DEPTH �$t ft <br /> DISTANCE TO NEAREST WELL i�_ ft FOUNDArIOrd S16, ft PROPERTY LINE �� It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> [!rUNW_9M,A48 o! J AM? - Q NOTfCF_ REQUIRED FOR INSPECTIONS -PLEASE LEASE CAL (299)953-7697 <br /> SIGNED o/!� TITLE Y`r�r DATE IIIf o lcf <br /> -- — — — — <br /> ------ ---- — - y <br /> —-- -- -- — — — A, <br /> 10 <br /> I I <br /> ----- --- - - --- - - nr-pARrmr-Nr sr Ivy v <br /> Application Accepted By Date <br /> �� Area Employee ID#/–� <br /> Final Inspection By _ - Date '7 P 0 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth 3 Ft: _ PiilSul7Vharacter: <br /> COMMENTS <br /> rev -4R- arm -�. - -kms <br /> as / � - _ - - --- - - <br /> PE SC P.eceived heck## Amount Dato Permit/ Invoice It Permit ID#t <br /> Code INFO By ash Remitted _ Service Request it <br /> 6 0 5800814 35 <br /> 42-0I ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> d/11l1Y <br />