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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT - CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS It `]f tJ -7 W LVC LL 14d [' CITY/ZIP uiL Ke - � J� ` I �JG2I <br />CROSS STREET APN 0 OG PARCELSIZE _03 <br />'OWNER NAME PHONE <br />OWNER <br />Clio <br />OWNER ADDRESS I �ji�—�, % /� CITY/STATE/ZIP <br />Ca <br />CONTRACTOR ��C � `? V_ / w/ ` PHONE 0 <br />CONTRACTOR ADDRESS /CJ O/S pr, CITY/STATE/ZIP r 5-ep <br />LICENSE ❑XI -42 ❑ C-36 OTHER NUMBER J / e %EXPIRATION DATE <br />WATER TABLE DEPTH:y S ft GEOGRAPHICAL INFORMATION: Coordinates X _ Y <br />Cl PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I I ENGINEER DESIGNED/ALTERNATIVE <br />REPLACEMENT Ll OUT -OF -SERVICE SEPTIC SYSTEM 1 DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: ` NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG <br />❑ GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />❑ LIFT STATION SIZE TYPE OF PUMP <br />CAPACITY <br />CAPACITY <br />It FOUNDATION _ <br />❑ PKG TX PLANT <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />VIRED FOR INSPECTIONS - <br />DEPARTMENT USE ONLY <br />Application Accepted By - Date i Area. <br />Final Inspection By Date ,� SPECIAL PETN <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil? <br />aracter: S� <br />COMMENTS S er ' u 14C K d SO,4 bAC K <br />�0 M 17A1;C. we /I �) r- n 0 AVG:IabIQ SAd(P Gr' <br />1. he ( <br />