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