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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET- STOCKTON CA 95202 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7669x7 FOR INSPECTIONS EXPIRES I YEAR FROM DA'YE ISSUM), <br />JOB ADDRESS _ -5 7 O Y- CITY/ZIP •f-/< 7y� <br />CROSS STREET r � % APN 2!6: rCl Z'1^ PARCEL SIZE tea. <br />OWNER NAME_J`Gt�� „G"J �l. 1 J e .. PHONE <br />OWNER ADDRESS {Z •'"".T_ '"' 'G L.t_ CITY/STATE/T.IP '' AI. 7 �� <br />CONTRACTOR aC2 1 IS b�:.-..++– _ PHONE <br />CONTRACTOR ADDRESS �' 5X _ CITY/STATEMP t•�✓`' <br />LICENSE S C-42 ❑ C-36 OTHER �' NLNHER �� EXPtRAT10N DATE ® <br />WATER TABLE DEPTH. _ ft GEOGRAPHICAL <br />❑ PERC TEST # BUILDLNG PERMIT i <br />TYPE OF WORK: 111 NEW INSTALLATION ❑ <br />❑ REPLACEMENT _ <br />LNSTALLATION WILL SERVE: RES/IDEN.�_� <br />NUMBER OF LMNG UNITS: ! '� N�ER OF <br />Coordinates X Y <br />�U O LAND USE APPLICATION 4 <br />_ ❑ DESTRUCTION <br />❑ COMMERCIAL 13 OTHER <br />BEDROOM$: _ - NUMBEROF EMPLOYEES: <br />❑ SEP77CTANK <br />❑ GREASE TRAP <br />❑ LIFT STATION <br />____ <br />TYPFJMFG;yz& -I Vigo <br />TrPE/MFG_ <br />DISTANCE TO NRAREST: WELL <br />SI7Y TYPE OF PUMP" <br />ft <br />LEACH! LINES <br />KL LEACHING CHAMBERS <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST N 100 + fl <br />❑ FILTER BED <br />Wtorm ft LENGTH <br />—_ ft PROPERTY LINE <br />ft <br />DISTANCE TO NEAREST WELL__ <br />h PO <br />❑ MOUNDED <br />WIDTH _ ft LENGTH <br /># OF NES <br />LI <br />DISTANCE TO NEAREST WELL _ <br />ft FO <br />❑ sumps <br />wm7N ft LENGTH _ <br />DISTANCE TO NEAREST WELL <br />_ fl FO <br />11 DISPOSALPONDS <br />WMTtl ft LENGTH <br />DISTANCE TO NEAREST WELL _. <br />ft F <br />❑ 3EEPAGEPITS <br />NUMBER WIDTH <br />ft PROPERTY LLINT,LINT,_ift <br />DISTANCE TO NEAREST WELL — <br />_ ft FO <br />CAPACITY <br />_ <br />OWDATION <br />__ <br />OLNDATTON <br />Eat # OF COMPARTMENTS <br />CAPACITY <br />gal # OF COMPARTMENTS <br />FOUNDATION <br />—_ ft PROPERTY LINE <br />ft <br />0 PKC TX PLANT <br />O SAND OIL SEPARATOR (ENCIASED SYSTEM) <br /># OF NES <br />LI <br />LENGTH OF LINES Q <br />FOUNDATION. <br />ft PROPERTY LINE <br />JT fl <br />DEPTH <br />_ <br />ONDATION _ <br />ft PROPERTY LLINT,LINT,_ift <br />ft <br />DEPTH _ — <br />_ft <br />Ut.'DAT1ON <br />ft PROPERTY LINE <br />ft <br />ft <br />DEPTH <br />ft <br />LNDATION <br />ft PROPERTY LINE <br />ft <br />ft <br />DbnR <br />ft <br />R PROPERTYLINE <br />ft <br />DEPTH <br />ft <br />ft PROPERTY LINE <br />ft <br />1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE wITH SAN JOAQUIN COUNTY <br />ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />4 HO I ADVANCE NOTICE REQUIRED FOR INSPECTIONS -- PLEASE CALL (209) 953-7697 <br />SIGNEDTITLE_ V `�`� �''� � DATE <br />DEPARTMENT IPF ONLYyJ�r <br />Application Accepttd By / �L Date Arca Emplaya IDA -" sI— <br />Flnal Iuspectbn Sy Dart Z- . 0 SPECIAL P'ER1yIT -Approved by _ <br />Character of Sail to Depth ora Ft _ Pi ump Sail Characaert <br />COMlMN'TSA)c- j LILA-A,C OKSEG'✓� <br />42-01 OKSITF WASTEWATER PERMIT <br />osn0+2007 <br />1 <br />