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J .Iv''4 ,1111,. 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 209 953-7697F0 INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE[ JOB ADDRESS AA (J {� ` `' S I ER CITY/ZIP/� N 0 CROSS STREET C /� A )�` I�\�!-1��r��S C� APN�29A ©l✓L%' PARRCELSIZE,�AC.itci OWNER NAME J ,4,o j V eWc /. l^y�nu� i ri Ce ('� PHONE Z/6A FS— � 5� OWNER ADDRESS %y/y, -CA", uz/I 0L), -j S �` CITY/STATE/ZIP - PV/6 / .:] 2,U Cry CONTRACTOR S G wl c XL 9 PHONE CONTRACTOR ADDRESS CITY/STATE21P LICENSE ❑❑C-42 00C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED /ALTERNATIVEA n REPLACEMENT n OUT -OF -SERVICE SEPTIC SYSTEM %<DESTRUCTION2 S" r&, A^ INSTAL LATIONWILL 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 WIDTH DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE fl ❑ LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES I I LEACHING CHAMBERS # OF LINES LENGTH OF LINES fl o DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH p It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft ❑ MOUNDED WIDTH It LENGTH It DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY UNE ft ❑ SUMPS WIDTH ft LENGTH ft 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 UNE 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. DEP MENT USE O LY Application Accepted �� IO PO K Date Z Area r /q 9 Employee ID# tri �r Final Inspection B - Date ❑ SPECIAL PERMIT -Approved by Character of Soil t pth oY 3 Ft: Pit/S mp/Soil Character: COMMENTS 6 42 042e ctrtA %LW sr df Li�c.y c,�Ms� ruu, ✓�o( �v vcz �eccru� 7'6.1k /� �f fr.r/ I _ I I ""Z"'" I I _7"""". I Date I _ _ " ... I Invoice# I Permit ID# I 42-01 4/24/12 -w f V\O,+ -7 L4,1 - ONQSRE WASTEWATER TRTMNT SYS EMfMR CL14 i— rt� ik-kwi 4 mss reser 60.4 -- 7:;p S c.CJ C W; W V: o = j CV W� m Z p Z W DEP MENT USE O LY Application Accepted �� IO PO K Date Z Area r /q 9 Employee ID# tri �r Final Inspection B - Date ❑ SPECIAL PERMIT -Approved by Character of Soil t pth oY 3 Ft: Pit/S mp/Soil Character: COMMENTS 6 42 042e ctrtA %LW sr df Li�c.y c,�Ms� ruu, ✓�o( �v vcz �eccru� 7'6.1k /� �f fr.r/ I _ I I ""Z"'" I I _7"""". I Date I _ _ " ... I Invoice# I Permit ID# I 42-01 4/24/12 -w f V\O,+ -7 L4,1 - ONQSRE WASTEWATER TRTMNT SYS EMfMR CL14 i— rt� ik-kwi 4 mss reser 60.4 -- 7:;p