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vrv011 I r- VVA0 i tVVA I tK I HEATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET- STOCKTON CA 95202 - (209) 468-3420 fVUN-KEFUNDABLE HERMIT C r}-� CALL /�209 953-7697 FOR INSPECTIONS A EX^PIRES 1 YEAR FROM DATE ISSUE[ Joe ADDRESS -rte," E. J � e -F (�D CITYIZIP Ac-y-tpo qS- ZZ -D CROSS STREET W S -T )? (� APN D[ -:� — �S� `' l JAPARCEL SIZE '�t• 4o i4m• OWNER NAME j �Gl-F(2.h t' h ' 1 PHONE (P23 OWNER ADDRESS S I''Gy►nE CITY/STATE/ZIP CONTRACTOR LW P0. 0 /E�njV ►(?�o�.1 W1 Fj.� i t�'t L PHONE ✓�^ CONTRACTOR ADDRESS -I • o rC w— „ST• CIN/STATE/ZIP L"0�1 � Q 1 S -Z ' V LICENSE QC -42 OC -36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: IT L) R GEOGRAPHICAL INFORMATION: Coordinates X Y Received PERC TEST # I BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDrnON ❑ ENGINEER DESIGNED /ALTERNATIVE INFO B 0 REPLACEMENT ❑ DESTRUCTION Remitted 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: VVELL 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 R FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION - ft PROPERTY LINE 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 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILLBE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMU 0 ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE t:6 NSV U-T"I^-T 11 C 3— Sy/ o DATE 6 Final Inspection By Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE Sc Received Check#! Amount Permi" Code INFO B Cash Remitted Date Invoice # Permit ID# Service Re uest # a2 -O7 • ^•^� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT