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I LP ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTHEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT / " yC' 5 % j CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 43 d u e 6/ Co CITY/ZIP !!t e -A- CROSS STREET W =� C� S�� Prj Cql t1 APN 0o 53&,0o5 PARCEE/L SIZE ✓� J OWNER NAME Th at) L/ U/ C Qe L i-, `% PHONE " y.2-- / OWNER ADDRESS S C M L�- CITY/STATE/ZIP CONTRACTOR Cx i/Itni+�'� V tI �jkr � JCfT}�� PHONE :_-,) 0f% , 3[041- !!!; -0 7 CONTRACTOR ADDRESS d� I (.�1 S��T Vr �J CITY/STATE/ZIP d, LICENSE -42 1 IC -36 OTHER NUMBER ��/ �� EXPIRATION DATE C� WATER TABLE DEPTH: 7 +7 ft GEOGRAPHICAL INFORMATION PERC TEST # BUILDING PERMIT # A- / Coordinates X Jaz '; V LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM INSTALLATION WILL SERVE: > RESIDENCE 1 I COMMERCIAL NUMBER OF LIVING UNITS: s'I SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG NUMBER OF BEDROOMS: L DISTANCE TO NEAREST: WELL o-�OC ft ❑ LIFT STATION SIZE TYPE OF PUMP Y ENGINEER DESIGNED /ALTERNATIVE DESTRUCTION _I OTHER NUMBER OF EMPLOYEES: CAPACITY gal # OF COMPARTMENTS L12 � CAPACITY gal # OF COMPARTMENTS --w r / FOUNDATION J ft PROPERTY LINE 3! ft ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) DEPARTMENT U E ONLY Application Accepted By l Date %U "� Area / % q Employee ID# 7— Final Inspection By Date I ] SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 F : Pit/Sump Soil Character: COMMENTS 3cc- n,,•)�o Je f�1u L ."4 S ��+Lw- r� sU� m.If PE Code LEACH LINES LEACHING CHAMBERS # OF LINES _ LENGTH OF LINES 5S ft Amount Remitted Date j DISTANCE TO NEAREST WELL ft FOUNDATION S t ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft SP,cvS DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIN ' ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ECT ice_ ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LI% �T PSL! ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH `' b' )04-% ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPER ft L3DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH V IN COCO ^ITI_ ft n SEEPAGE PITS DISTANCE TO NEAREST NUMBER 3 WELL WIDTH ft FOUNDATION - ft PROPERTY L � D "' ft 4,9 i, ft DEPTH ;9 / T ft DISTANCE TO NEAREST WELL C ft FOUNDATION ft PROPERTY LINE r ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILtt , ILffiL 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 /r!/ TITLE 6.rnjddc' DATE 141 fG -1 DEPARTMENT U E ONLY Application Accepted By l Date %U "� Area / % q Employee ID# 7— Final Inspection By Date I ] SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 F : Pit/Sump Soil Character: COMMENTS 3cc- n,,•)�o Je f�1u L ."4 S ��+Lw- r� sU� m.If PE Code Sc INFO Received PAk ec sh Amount Remitted Date j Permit/ Service Request # Invoice # Permit ID# 91)) I)T /93 SS) SP,cvS 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/24/12 T Y v v z U