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P /' ONSITE WASTEWATER TREATMENT SYSTEM PERMIT &AN JOAQUIN COUNTY ENVIRONMENT AL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE P JOB ADDRESS CALL (209) 953-7697 FOR INSPECTIONS CITY/ZIP EXPIRES 1 YEAR FROM DATE ISSUEI CROSS STREET �4_ , ew'4i li_/i/ APN�j 0 A -7 0 9 � I t � PARCEL SIZE 2/`. 7 OWNER NAME as r!..��L y N , n h -DiP ( LV PHONE�i��,� L`1� OWNER ADDRESS LL// CITY/STATE/ZIP CONTRACTOR/C P��J�/i11�i�/�/./ G - _ PHONE !g:a2 - CONTRACTOR ADDRESS C�� ji/_ Ys CITY/STATE/ZIP LICENSE '1&-42 ❑C-36 OTHER NUMBER.��EXPIRATIONDATEL/"ti' WATER TABLE DEPTH: 1i ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT #_ i 7j 606 51 LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION v I REPAIRIADDITION LI ENGINEER DESIG D/ALTERNATIVE REPLACEMENT 3)7 S f P 1 OUT -OF -SERVICE SEPTIC SYSTEM X DESTRUCTION1 INSTALLATION WILL SERVE: VeRESIDENCE NUMBER OF LIVING UNITS: A/ SEPTICTANK ❑ GREASE TRAP ❑ LIFT STATION TYPE/MFG V_ I v ❑ COMMERCIAL ❑ OTHER NUMBER OF BEDROOMS: Y NUMBER OF EMPLOYEES: CAPACITY Z� — gal # OF COMPARTMENTS �- TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL S'� / ft FOUNDATION , ft PROPERTY LINE r -L ft SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) I � LEACH LINES iK LEACHING CHAMBERS # OF LINES_ LENGTH OF LINES G It DISTANCE TO NEAREST WELL ,rp,z ft FOUNDATION %/% �� ft PROPERTY LINE e - It ❑ FILTER BED WIDTH LENGTH DEPTH 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. SIGNED Application Accepted By VU Final Inspection By 147. Character of Soil to Dep of 3 t:f COMMENTS kelplatc, Its; CALL (209) 953-7697 DATE DEPARTMENT USE ONLY n Date U") ' ') Area L � 9 Employee ID# Date 3 3 ❑ SPECIAL PERMIT - Approved by Pit/Sump Soil Character: irr m ij Jr I a J0 i 4 i a A J. tui I ml� ul X PE Code DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE pAl. ft ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft ��'�"ww7777ft Permit ID# DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ElSUMPS WIDTH ft LENGTH ft DEPTH ac w ICU It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY 15i E ft ❑ DISPOSAL PONDS WIDTH ft LENGTH "U' 0An,,,._ ft ft DEPTH DISTANCE TO NEAREST WELL ft /� FOUNDATION ft PROPERTYL VVIRO-Ify C ft �> Ep SEEPAGE PITS NUMBER WIDTH lj% ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ,jO 1 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. SIGNED Application Accepted By VU Final Inspection By 147. Character of Soil to Dep of 3 t:f COMMENTS kelplatc, Its; CALL (209) 953-7697 DATE DEPARTMENT USE ONLY n Date U") ' ') Area L � 9 Employee ID# Date 3 3 ❑ SPECIAL PERMIT - Approved by Pit/Sump Soil Character: irr m ij Jr I a J0 i 4 i a A J. tui I ml� ul X PE Code SC INFO Received B Chec �sFl Amount Remitted Dae Permit/ Service Request #Ly Invoice # Permit ID# ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/24/12 T