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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUN A LE PERMIT�� : CALL 9j 953-7697 FOR INSPECTIONS , EXPIRES 1 YEAR FROM DATE ISSUED ,Ali -ffl�JOB ADDRESS _ CROSS STREET OWNER NAME C OWNER ADDRESS �^ • b3D 41 , PARCEL SIZE PHONE..—ILP CONTRACTOR ADORES} y■��. rry-ee� /��r��{�TM� CITY/STATEMI LICENSE I C-42 I•r1.-36 OTHER T1 NUMBER�.JG{-/KV a EXPIRATION DATE WATER TABLE DEPTH: ❑ PERC TEST S TYPE OF WORK: NEW INSTALLATION REPLACEMENT ft GEOGRAPHICAL INFORMATION: Coordinates X y BUILDING PERMIT # LAND USE APPLICATION # .. REPAIR/ADDITION ENGINEER DESIGNED IALTERNATNE OUT -OF -SERVICE SEPTIC SYSTEM I DESTRUCTION INSTALLATION WILL SERVE: I I RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG CAPACITv 2_ gal • OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE 70 NEAREST: '��. �-- WELL ft FOUNDATION It PROPERTY LINE �_fl X LIFTSTATION SIZE TYPE ❑ � PKGTXPLANT Cl SAND OIL SEPARATOR (ENCLOSED SYSTEM) REPLACEMENTQfQ2O411yBUfION ACE AREA {OFFPUMP LEACH LINES LEACHING rA. # OF LINES LENGTH OF LINES —L.J fl DISTANCE To NEAREST WELL 3W It FOUNDATION 1!j D It PROPERTY LINE 851101_ A ❑ FILTER BED WIDTH It LENGTH It DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE fl ❑ MOUNDED WIDTH ft LENGTH It DEPTH fl DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH it LENGTH It DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH It LENGTH R DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH fl DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE fl 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. 1 IMUI! 24/AbU1aA IVAN OTICE REQUIRED FOR IN ECTIONS - PL ASE CAL 209 953-1697 SIGNE TITLE - " — DATE - III a Applic3tioo A opted By Final Inspection By_ Character of Soil t4eptl COMMENTS Aqr F- — �— — — — — .NfRCIAL � — iRPs'P ..... K PRluln lr/101RmAi11— 1.]5'e I— PVC tRANSPORi RPE DEPARTMENTUSE ONLY of 3 Ft: Dale Area Employee IDS Date SPECIAL PERMIT - Approved by Pit/Sump Soil Character: PE SC Received Checks/ Amount Date Permitt Invoice # Permit IDS _Code INFO By Cash Remitted Service Request # a4 -L- 5,3 t 1 "4'J 42'01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4124/12 i mla• (TW) -- - - i10'-0' ee sDRis wr. RPC nvP1 •Ij/�, /j,�� BOX r� REPLACEMENTQfQ2O411yBUfION ACE AREA I roRIQTeBol�il�'t/�. A.� Applic3tioo A opted By Final Inspection By_ Character of Soil t4eptl COMMENTS Aqr F- — �— — — — — .NfRCIAL � — iRPs'P ..... K PRluln lr/101RmAi11— 1.]5'e I— PVC tRANSPORi RPE DEPARTMENTUSE ONLY of 3 Ft: Dale Area Employee IDS Date SPECIAL PERMIT - Approved by Pit/Sump Soil Character: PE SC Received Checks/ Amount Date Permitt Invoice # Permit IDS _Code INFO By Cash Remitted Service Request # a4 -L- 5,3 t 1 "4'J 42'01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4124/12