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ONSITE WASTEWATER TREATMENT SYSTEM PEP -MIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL It EALTII DEPARTMENT 304 E WEBER AVE - 3Y° FI. - STOCKTON CA 95202 - (209) 465-3420 <br />NOIN-KEFUNDABLE PERMIT t-ALLJZUV) yes -rove POR INsrct I IONs LAPIK@:N I YEAR FROM DATE ISSUED <br />JOB A•)DRc%s l0 l ✓l pfm—N iu(!,!— _ CITY/ZIP <br />CROSS STRF-F.T APN —j _ PARCEL SIZE <br />OWNER NAME %` lLc''A 4Pf'4 PHONE <br />OWNER ADDRL_S ,J�1CafM�/ ,q CITY/STATEILIP �Y <br />CONTRA( -TOR _ I�(� 1 �` �S Q ifs q q t,- -L �� _ _ PHONE /% <br />CONTRACTORADDREL"S p�n —F]� '�n.�n CITY/STATEJZ1P �Q^T`Q.C-Yi- 43A45336 <br />LICENSE U C-42 ❑ C-36 OnIER _f7 NUMBER(0dj,!M4 EXPIRATION DATEJT <br />WATER TABLE DEPTH: _ It GEOGRAPHICAL INFORMATION: Coardlnates X <br />❑ PERCTEST(S) NUMBER LAND USE APPLICATION T <br />TYPE OF WORK: Q NEW IN'STALLAT'ION REPAIR/ADDfI"ION ❑ ENGINEER D'eSIGNED /AI.TERNA,4" <br />❑ REPLACEMENT ❑ DESTRUCT ION <br />INSTALLATION WILL SERVE: ErRESIDENCE❑ COMMENCIAL ❑ O"FHER <br />NL.MBENOFLIyINGUNI'I'S: t NumsER OF BEDR)OMS: NCMBFROFEMPt.OYEES: <br />❑ SEPTICTANK TYPE/MFG CAPACITY gal /OFCOMPARTMFNTS <br />❑ GREASE TRAP TYPE/MFO CAPACITY'_ _ gul 0 O COMPAR"IMEN "IS <br />❑ PKC TX PLANT DISTANCE TO NEAREST: WELL H FouNDAIION H PROPERTY LINE 1t <br />❑ LIF -I' STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />., '/ <br />Qr LE,ACH LINES <br />0 LEACHING CHAMBERS <br /># OF LINCs <br />_ <br />/� r <br />LENGTH Of LINES "lid ft <br />DISTA:NCETONEAREST <br />WE:.L <br />H FOUNDATION <br />H PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />_ H <br />LENC,TH <br />H <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />_ H FOUNDATION <br />_ <br />_H PROPERTY LINE }l <br />❑ MOUNDED <br />WIDTH <br />it <br />LEN: TH <br />H <br />DEPIN H <br />DISTANCETO NEAREST <br />WELL <br />_ it FOUNDATION` <br />Ft PROPERTY LINE________ H <br />O SUMPS <br />WIDTH <br />tt <br />LENGTH <br />ft <br />DEPTH H <br />DISTANCE TO NEAREST <br />WF"I 1. <br />_H FOUNDATION <br />_II PROPERTYI.INE_ _ H <br />❑ DISPOSAL PONDS <br />WIDTH <br />it <br />LENGTH <br />ft <br />DEPTH H <br />DISTANCE TO NEA REST <br />WELL <br />H FOUNDATION <br />ft PROPERTY UNT H <br />�,/ <br />Cf SEEPAGE PITS <br />WIDTH �Gu <br />tt <br />L211Ivc1-1 ' I <br />ft <br />DEPTH_4Sr - H <br />DISTANCE To NEAREST <br />WELL <br />It FOUNDATION <br />H PROPERTY LINE H <br />1 HEREBY CERTIFY "T'HAT I HAVE. PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDIN'ANC F:S, <br />STATE LAWS AND RUI.F,S AND REGULATIONS OF SAN JOAQCIN COUNTY. <br />JJ <br />MINIMI 24 HOUR ADVANCE NOTICE REQUIRED FOR INSP/EGCTIONfSS-PLEASE CAL& 009) 953-76� <br />SIGNED l�l�' _ TITLE _ [ TCD �'�� �'E <br />IlEPARTMENT USFONIX <br />Application Accepted B�� Date / Area _ Employee ID <br />Final Inspection ❑ SPECIAL PERMIT -Approved by _ <br />Character of Sol[ to Dep ! of 3 FI: iii Pit/Sump Soil Character: <br />COMMENTS 0 <br />PE SC Received eck# Amount Permit/ <br />Code IYFO B ash Remitted Date Service uest# Invoice# Permit llAY <br />i2 -D1 -Ml <br />1212;02 ONSITF" WAS"fFWATER PERMIT <br />