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c t <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95215-(209)468.3420 <br /> NON-REFUNDABLE PERMIT 1CAL/L_ 209 953-7697 FOR INSPECTPONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS j I'� V' S Ohio, U C4. crrymp 4j Q <br /> //11 T' // a <br /> CROSS STREET ( ,pY}r.l 1 Yl APN r��L nJ' a PARCEL 5� a a S <br /> OYMER NAME 1 (11/1,-YRIONlE,�O�(•�d(� <br /> OWNER ADDRESS i I.�./ S. V��I,),-( p"I CITYISTATEMP .�-I IA rC to CQ 7 <br /> CONTRACTOR nWIILlvr PHONE <br /> CONTRACTOR ADORM CITYISTATEMP <br /> LICENSE ' C412 n cw oum NUMBER ExP+RATIoN DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICALINFORMAnoN: Coordinates X Y <br /> I <br /> PERC TEST S BUILDING PERMIT# LAND USE APPLICATION#__ <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADOrnoN ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM i DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LNNG UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT D SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEAGNLNES LEACHING CHAMBERS #OFLNEs LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY UNE It <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH_ ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY UNE ft <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY UNE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUhVW-R WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> 1 HEREBY CERTIFY TNATI HAVE PREPARED THIS APPLICATION AND THE WORK MALL BE DOME IN ACCORDANCE MATH SAN JOAGUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUMU ADVANCE NOTICE REQUIRED OR INSPECTIONS-P 09 9J53-769 <br /> SIGNED TITLE T�VI :.Y DATE. <br /> S <br /> PAY <br /> m o <br /> RFCE 1 1 .1 H <br /> s <br /> r <br /> jOAQU( l DEPARTMENT '' Y <br /> SAEN�RONM*.nal <br /> AL AcceptedBy_���v Elate 3, ad Arec;n}Pc�+ ErnpoyeeIDN AS <br /> H�LTHDEPction By Dabe2/ T�_ c SPECIAL PERMR-ApprwBdoy t <br /> Character of Soil tD U f PRISUM*SM U N�O� <br /> COMMENTS -i)h I 8v�BI' 3 6 <br /> 4,1:G - 5 I d -� M frit t <br /> - j r Act dt"�o <br /> Code W ReeeNed Cho" � O84 Penn u # invoke• Pendt IDI K h AA* <br /> 1 opsI Asa 4 g2�2 <br /> 42-01 I /I I�!t ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14118 ••y 1 "`���"`��� <br />