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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1/,YEAR FROM DATE ISSUED JOB ADDRESS b0I4 0) ELAS T Orf N Ey L^%, E. i L CITY/ZIPJ� �- (/' CROSS STREET L/� t ` , _ + �^ APN64" 070' � PARCEL SIZEq. OWNER NAME L(3` UQ ► Sr _ 1. [��r�i- nch h e -S PHONE 1 t T OWNER ADDRESS Al"1L >nb (��`J i r CITY/STATE/ZIP L2p% Cv��j '9 G Llb CONTRACTOR W E,S� C�S'I bA0-'0AUC c W L PHONE CONTRACTOR ADDRESS 2a:II -r ^)t W E t CITY/STATE/ZIP a LICENSE 1_', C-42 I_': C-36 OTHER N NUMBER 85its-j EXPIRATION DATE y WATER TABLE DEPTH: J ft GEOGRAPHICAL INFORMATI N:Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: X RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: A NUMBER OF EMPLOYEES: fiD SEPTIC TANK TYPE/MFG P+L- ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL ❑ LIFT STATION SIZE TYPE OF PUMP CAPACITY gal # OF COMPARTMENTS-7- CAPACITY OMPARTMENTSZCAPACITY gal # OF COMPARTMENTS ft FOUNDATION IV ft PROPERTY LINE �` ft ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES r-4, LEACHING CHAMBERS 1 IV f �( # OF LINES LENGTH OF LINES ft Check r4 DISTANCE TO NEAREST WELL ft FOUNDATION LJ� j ft PROPERTY LINE 25=+ ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft ✓✓✓��' W DISTANCE TO NEAREST WELL ft FOUNDATION SUMPS WIDTH iw 1 ft LENGTH ft ft PROPERTY LINE ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO CIEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER 4- WIDTH bbl ft DEPTH 2. S ft DISTANCE TO NEAREST WELL A SC -1, ft FOUNDATION i J3 ft PROPERTY LINE i V'i 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 tr TITLEF7: C.� O C�� DATE Application Accepted B Final Inspection By Character of Soil to Dw COMMENTS t1 /Mq Vu� -#EPARTMENTLISEONLY Date Area Employee ID# DatG a II SPECIAL FGMIT -Approved by rV� Pit/Sump Soil Character: I!J PE Code SC INFO Recei ed Check Amount emitted D e Permit/ Service Request# Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/24/12 r r L/