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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-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS ,� _ —CITY/ZIP CROSS STREET APN*24� C'9 0\ % PARCEL SIZE OWNER NAME cAlan 'J (1" PHONE/PLI OWNER ADDRESS� &'PH ^5� lon C .--CITY/STATE/ZIP i{lfJ� CONTRACTOR _ PHONE ❑ CONTRACTOR ADDRESS CITY/STATE/ZIP It LICENSE ❑CIC -42 ❑❑C-36 OTHER NUMBER,,–__ EXPIRATION DATE WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinate X Y ❑ PERC TEST # BUILDING PERMIT # N o ;;IrAND USE APPLICATION # TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ DDITIO ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT I I OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE 1-1 COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK FG Y (Z� �� CAPACITY (gal # OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG —_ CAPACITY gal N OF COMPARTMENTS DISTANCE TO NEAREST: WELL It FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE _ TYPE OF PUMP__—__ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) SIGNEla*il�b�""�„�,�+—� — TIM t_�iK— DRTE G 'I`!1 DA jo_ o° oar Y ._—j'8or rf: �oti. ,I IImo.ZAPrt... k -1:.0A RTMET USE OAre Y Application Accepted By v=(� Date 7 S / 1 Area u i(c �i Employee IDIF Final Inspection ByDate ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS OL _L„_ �—_o�I_ 171 -«.i� 3 (3L M 4.D t�lf k/�� SS/ i'L lfSl 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4124112 LEACH LINES ❑ LEACHING CHAMBERS-------.,--------- NOF LINES �.. LENGTH OF LINES 9, C> It DISTANCE TO NEAREST WELL It FOUNDATION _ It PROPERTY LINE It ❑ FILTER BED WIDTH ft LENGTH ^ ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION Il PROPERTYLINE ft ❑ MOUNDED WIDTH It LENGTH It DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ED It ❑ SUMPS WIDTH It LENGTH 1l DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY'�NE ft E3 DISPOSALPONDS WIDTH 1t LENGTH ft DEPTH A QAQ� IN CO yr env— DISTANCE TO NEAREST WELL It FOUNDATION PROPERTY JMALT_H TQ� It _-ft nF^ ^ ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH DISTANCE TO NEAREST WELL It FOUNDATION It 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, i STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. SIGNEla*il�b�""�„�,�+—� — TIM t_�iK— DRTE G 'I`!1 DA jo_ o° oar Y ._—j'8or rf: �oti. ,I IImo.ZAPrt... k -1:.0A RTMET USE OAre Y Application Accepted By v=(� Date 7 S / 1 Area u i(c �i Employee IDIF Final Inspection ByDate ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS OL _L„_ �—_o�I_ 171 -«.i� 3 (3L M 4.D t�lf k/�� SS/ i'L lfSl 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4124112