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P V-8 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1368 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT LEACH LINES ❑ LEACHING CHAMBERS # OF LINES _7 LENGTH OF LINES SS CALL ZUy Ub-'-/tiy/ FOR INSPECTIONS LXPIKES 'I Y LAR FROM L)A It ISSUtl JOB ADDRESS 1 CI Cl -I v- WELL it FOUNDATION 95 ✓ ft PROPERTY LINE ft ❑ CITY/ZIP ft LENGTH ft DEPTH - CG« DISTANCE TO NEAREST /��✓ 0—M SIZE CROSS STREET / 'r� U MOUNDED WIDTH ft LENGTH ft DEPTH FP0 APN V PARCEL OWNER NAME v''�I �t'✓d / /" ¢ / � �J —61e/7 JC` � 4• � 1 O / � PHONEI '�� M� l.Y ��/ sumps WIDTH ft LENGTH ft DEPTH Jpq b /'%7%��S ", DISTANCE TO NEAREST OWNER ADDRESS ❑ DISPOSAL PONDS WIDTH / VjPj CITYISTATEIZIP /n CONTRACTOR DISTANCE TO NEAREST 1k,� _!;%17h O PHONES CONTRACTOR ADDRESS (� %I SC %'i /d'^ - CITY/STATE/ZIP LICENSE ❑) -42 ❑LC -36 OTHER ft NUMBER }S die) S EXPIRATION DATE q CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, Q 0 F 1 � WATER TABLE DEPTH: I to � � �� ft GEOGRAPHICAL INFORMATION: Coordi ates X Y ❑ PERC TEST # BUILDING PERMIT # r AND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION l_I PAIR/A DITION -1 ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT G OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: % RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: 0 / ryNUMBER OF BEDROOMS: -3 NUMBER OF EMPLOYEES: ) XSEPTIC TANK TYPE/MFG Cel mk ' � CAPACITY 1,;20L/ gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS i / _ DISTANCE TO NEAREST: WELL 3�0 ft FOUNDATION 15- ft PROPERTY LINE JGC � ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) SIGNED TT Xpplication Accepted By Final Inspection By Character of Soil to Depth of 3 COMMENTS TITLE DATE ci —1-5--1 P, Date J Area v Employee ID# Date P ❑ SPEC ��ERMyj Approved by Pi um Soil Character: PE Code LEACH LINES ❑ LEACHING CHAMBERS # OF LINES _7 LENGTH OF LINES SS ft Ua—sh DISTANCE TO NEAREST WELL it FOUNDATION 95 ✓ ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH 22 Z / � S � •Q `7 .S DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ MOUNDED WIDTH ft LENGTH ft DEPTH FP0 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ,qN ,"ry- 21*4 Ll sumps WIDTH ft LENGTH ft DEPTH Jpq b DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE �_TV_ O'VLP: Ou T ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH pgRr ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE SEEPAGE PITS NUMBER g WIDTH qa /, ft DEPTH '�) S7/ ft DISTANCE TO NEAREST WELL ft FOUNDATION ©r ft PROPERTY LINE CC) F ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TT Xpplication Accepted By Final Inspection By Character of Soil to Depth of 3 COMMENTS TITLE DATE ci —1-5--1 P, Date J Area v Employee ID# Date P ❑ SPEC ��ERMyj Approved by Pi um Soil Character: PE Code SC INFO Received Byn Ua—sh Amount Date Permit/ Invoice # Remitted J Service Request # Permit ID# l 22 Z / � S � •Q `7 .S 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/24/12 H a c c M