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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P z <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue-STOCKTON CA 95205.6232 - (209( 468-3420 <br />IKON-KEFUNDABLE PERMIT <br />GALL 209 953.7697 FOR INSPECTIONS <br />EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS C, L <br />r <br />CITY/RIP'1 1T(1�' <br />` PI <br />I1 \ (.V:�7 �j G I - <br />'� L/ J <br />2L2 2q <br />/ I <br />Ll GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />CROSS STREET <br />2 APN `) <br />- <br />! V <br />PARCEL SIZE <br />OWNER NAME 1-lllill t 1 <br />C ". A (-:' 1-1 I d I \ <br />ft <br />PHONE .72 1- L - <br />OWNER ADDRESS <br />CITYISTATE/ZIP <br />DISTANCE TO NEAREST WELL it FOUNDATION fl PROPERTY LINE <br />CONTRACTOR�)� ��� <br />C �%£ (- f I <br />v <br />PHONE <br />DISTANCE TO NEAREST WELL It FOUNDATION f1 PROPERTY LINE <br />CONTRACTOR ADDRESS _(=aLDI•'� <br />n <br />/� f/ <br />.�,(1(�'�r(��1�� J'�� <br />CITY/STATE/ZIP M.cj <br />p <br />,, o �qS3 ' <br />LICENSE C-42 C-36 OTHER <br />/� <br />? ^ <br />ft <br />--? <br />. , �—j <br />NUMBER <br />EXPIRATION DATE <br />1/9 <br />WATER TABLE DEPTH: ..- ��,� f1 GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # _ BUILDING PERMIT;; _ LAND USE APPLICATION # <br />1 — V, VVUKM: NEW INSTALLATION REPAIRIADDITION ENGINEER DE51ONED /ALT RNATNE <br />Receive Chec #1 Amount Date PennlU Invoice # Permit ID# <br />Remitted Service Ro uest# <br />X REPLACEMENT DESTRUCTION <br />INSTALLATION WILL SERVE: K RESIDENCE COMMERCIAL OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />�7 <br />Z� SEPTIC TANK IYPE/MFG core (cf'-N' _ CAPACITY�20(3 Sal #OFCOMPARTMENTS- <br />Ll GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL It FOUNDATION It PROPERTY LINE <br />fl <br />❑ LIFT STATION SIZE TYPE OF PUMP ZI PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM( <br />Or LEACH LINES LEACHING CHAMBERS I # of LINES _ LENGTH OF LINES_ <br />ft <br />DISTANCE TO NEAREST WELL I 0 4— It FOUNDATION_ it PROPERTY LINE <br />❑ FILTER BED WIDTR ft LENGTH R DEPTH <br />ft <br />DISTANCE TO NEAREST WELL it FOUNDATION fl PROPERTY LINE <br />ft <br />❑ MOUNDED WIDTH ft LENGTH fl DEPTH <br />ft <br />DISTANCE TO NEAREST WELL It FOUNDATION f1 PROPERTY LINE <br />ft <br />❑ SUMPS WIDTH ft LENGTH R DEPTH <br />ft <br />DISTANCE TO NEAREST WELL it FOUNDATION R PROPERTY LINE <br />ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH <br />ft <br />DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE <br />ft <br />04 SEEPAGE PITS NUMBER I WIDTH I _31,'P ft DEPTH 7_- <br />ft <br />_ <br />DISTANCE TO NEAREST WELL R FOUNDATION i CS it PROPERTY LINE T1 <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 />SPATE LAWS AND�RUI/.,�S AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />M M U AN NQT"jC EOUftDF SPECTIO - P CALL ( 09(953-7697SIGNED YE DA <br />Application Accepted By <br />Final Inspection By <br />Character of Soll to De of <br />COMMENTS L otv <br />Pj) ,? F® <br />Nw H 018 <br />OFpgR� <br />MFNT <br />IRTMENT U O Y <br />Date Area Employee 1D#� <br />Date S SPECIAL PERMIT - Approved by <br />Soil <br />PE Sc <br />Code INFO _Cash <br />Receive Chec #1 Amount Date PennlU Invoice # Permit ID# <br />Remitted Service Ro uest# <br />42-01 � I ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />10/4107 <br />