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1011 •-ad fit, - `%. '-9 <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-KEFUND I RMIT (:ALL (ZUY) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI <br />JOB ADDRESS \-�.�.Y✓1 i j U CITY/ZIP <br />1 <br />CROSS STREET �,rjZ�J��1 L,�.J� _ APN LI(QIi 0'-�O PARCEL SIZE <br />OWNER NAME C,4ijE t:Ar- � Nf=4401Z I1 L. #AAgC- i'/VC• PHONE <br />OWNER ADDRESS 'Po 2?0 )c IDOb CITY/STATE/ZIP _ I./ Iik'l�� <br />CONTRACTOR PHONE _Q'IZA <br />CONTRACTOR ADDRESS CITY/STATE/ZIP fA <br />LICENSE I ' C-42 I_' C-36 OTHER NUMBER 6 001M EXPIRATION DATE I 302ZI 11-7 <br />1 � <br />WATER TABLE DEPTH: `u Q r ft GEOGRAPHICAL INFORMATION: COO r inates X Y <br />PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: x NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: I RESIDENCE X COMMERCIAL OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />Application Accepted <br />Final Inspection By_ <br />Character of Soil to D <br />COMMENTS y% <br />U ry L i <br />Area Employee ID# <br />4e— I1 SPECIAL PERMIT -Approved by <br />ump Soil Character: <br />v <br />PE <br />SEPTIC TANK <br />TYPE/MFG) CAPACITY 2-0010 gal # OF COMPARTMENTS <br />❑ <br />GREASE TRAP <br />TYPE/MFG CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />INFO <br />LIFT STATION <br />SIZE TYPE OF PUMP I O IaPM ❑ PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />Date <br />Service Request # <br />Invoice # <br />Permit ID# <br />LEACH LINES <br />LEACHING CHAMBERS # OF LINES <br />LENGTH OF LINES q 7 ft <br />grog <br />I I o'o . <br />DISTANCE TO NEAREST WELL 10 ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />FILTER BED <br />WIDTH ft LENGTH ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />MOUNDED <br />WIDTH ft LENGTH ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />SUMPS <br />WIDTH ft LENGTH ft <br />DEPTH ft <br />J <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />DISPOSAL PONDS <br />WIDTH ft LENGTH ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH It <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINE It <br />I HEREBY <br />CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />INIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697+ <br />SIGNED <br />1�7�-� TITLE ,5: 2 �;i"1< rt <br />DATE <br />Application Accepted <br />Final Inspection By_ <br />Character of Soil to D <br />COMMENTS y% <br />U ry L i <br />Area Employee ID# <br />4e— I1 SPECIAL PERMIT -Approved by <br />ump Soil Character: <br />v <br />PE <br />SC <br />Received <br />eck#I <br />Amount <br />Permit/ <br />Code <br />INFO <br />B <br />Remitted <br />Date <br />Service Request # <br />Invoice # <br />Permit ID# <br />grog <br />I I o'o . <br />tiR�i'-�c� <br />7 LIL <br />J <br />42 ; i �a2 �ls,��� i9A � ,.�� <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/24/12 <br />