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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPAR rMENT 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 .133/�79Gam- Vk O� CITY/ZIP Z- - . 85940 V CROSS STREET J k&k— •�'� APN � � 3 y l PARCEL SIZE ✓ ' p ty 0 7-q _/C JOWNER NAME tAOrf%a- O trM1417 PHONE OWNER ADDRESS CITY/STATE/ZIP Ld. C ^ q��7gO CONTRACTORCla,,qk ASVt-wt1*^ PHONE e - 313r7 - 180g19 6CONTRACTOR ADDRESS 65l-OVIAer Ty-. q� q CITY/STATE/ZIP �KiUAA��t�P�KtS, CA 95A�3 LICENSE El IC-42 ❑I IC-36 OTHER NUMBER t3nId39$ EXPIRATION DATE c'�I//7 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# 13 1) LAND USE APPLICATION# TYPE OF WORK: l REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: -�--RESIDENCE ❑ COMMERCIAL 1_1 OTHER NUMBEH OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTICTANK TYPE/MFG I u'�� CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS #OF LINES 4 LENGTH OF LINES �Lh It DISTANCE TO NEAREST WELL CCa ft FOUNDATION t 0 ft PROPERTY LINE S ft ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH —ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDA ION ft PROPERTY LINE ft SEEPAGE PITS NUMBER 2 WIDTH-y, 3,� � �a ft DEPTH Z ft DISTANCE TO NEAREST WELL L/ ft FOUNDATION C 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. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 9534697 SIGNED TITI F ;. �� c�.e - DATE '1/0-//61 r I {: � Q s I S 110 1 NTly —4J E144A .T Application Accepted By Date 2 ea �_ Employee ID#� Final Inspection By Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil 6haracter: ;wP COMMENTS M - M ( s S I Ppil•+ 4fi fi D IVAiy05 r2 Sc S 67(pl f, vum�r oWall 0 PE SC Received heck Amount 1Date Permit/ Invoice# Permit ID# Code INFO By ash Remitted I Service ✓Request# 42-01 P/�� Jl/J�T ! ( VONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/24/12