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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />r SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET - STOCKTON CA 95202 - (209) 468-3420 <br />I <br />RUN-MittUNUAULL r'tKMI I om., L ALLLUU V*J-/by/ FOR INSPECTIONS tCXPIRE5 l T FAR FR Tt 155UE <br />7— I <br />JOB ADDRESS 44 S Alw A] - „l E0ID C 'n�/' CITYR.�-T <br />IP ' I124m/� <br />CROSS STREET A� 0 W F -L- APN CO( —LID - 33s0 A -c <br />. ! pPARCEL SIZE <br />OWNER NAME ALF—Cy— TPA-0AFPrC.Ci E� PHONE `I (P- L�Z'SA- (04Gd LP <br />p <br />OWNER ADDRESS r - C) ' Fo7• (0'7-CITY/STATE/ZIP TFfDFN-Tam , cA <br />CONTRACTOR L -(\/E: QPW C1eVF- 1?2*jwttkM?k1L_ PHONE 7—o`E— 36,1 —o34 I� <br />CONTRACTOR ADDRESS t4 d � Vj'y! , � ST, CIN/STATE/ZIP L_OD I t Cox, { .SZTC) <br />LICENSE IC -42 IC -36 OTHER NUMBER EXPIRATION <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />1� PERC TEST # Z BUILDING PERMIT # LAND USE APPLICATION # PA - I f 0 G L 5 4p <br />TYPE OF WORK: NEW INSTALLATION REPAWADDITION I ENGINEER DESIGNED /ALTERNATIVE <br />:. REPLACEMENT DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ FILTER BED <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />It PROPERTY LINE <br />ft <br />❑ MOUNDED <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SUMPS <br />WIDTH ft LENGTH <br />It <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SEEPAGE PITS <br />NUMBER WIDTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND <br />REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMU HOUR ADVANCE NOTICE REQUIRED <br />FOR INSPECTIONS - PLEASE CALL <br />(209) 953.7697 <br />SIGNED <br />TITLE CpNS'J�'i <br />DATE I —�---j ,( <br />I LL <br />TFT F. <br />\\ <br />DETAIL <br />SEE DETAIL <br />�I <br />'b DEPARTMENT SE OILY <br />Application Accepted B to Area <br />Final Inspection By V melte c( <br />Character of Soil to Depth o Ft: (/ Pit/Sump Soil Char c <br />COMMENTS - ,, v -C r, 1 1,k4 Irk r,t"n i,,p <br />■0_ <br />I <br />.i <br />MINT <br />RECEIVED <br />NN 10 2m <br />IVIRpUI4 jV COUN7 y <br />T y Dfr Z'RTMENT <br />Employee ID#� <br />Approved by <br />rrl�, "k - 16 f -t <br />PE SC Received hec Amount Date Permit/ Invoice # Permit ID# <br />Code INFO BV ash RemitteA Service Request <br />?� 1 $ 1601M 5r LX:>Q6i <br />42-Ot ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />