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Zo -W)A- ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 NON-REFUNDABLE PERMIT CALL 0 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS CITY/ZIP JnAl CROSS STREET Yf�"I APN CJ ^ PARCEL SIZE A 7 L��, p OWNER NAME JL V V r - PHONE � -71-f-7 gY� 9 OWNER ADDRESS f + "" CITYISTATE21P CONTRACTOR^�► V 1,t N'l /�� PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑C-42 I)C36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: C ordinates X Y ❑ PERC TEST # BUILDING PERMIT# -» AND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED 1ALTERNAT E REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE 17COMMERCIAL ❑ OTHER n`{ NUMBER OF LIVING UNITS: ( NUMBER..OF BEDROOMS: 77 NUMBER OF EMPLOYEES: l�f (SEPTIC TANK TYPEIMFG Pd--:L— CAPACITY t gal #OF COMPARTMENTS O GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL 61 _ ft FOUNDATION I'O4 ft PROPERTY LINE iq ft 0 LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) 0 LEACH LINES ❑ LEACHING CHAMBERS i #OF LINES Q LENGTH OF LINES 7,5--r ft DISTANCE TO NEAREST WELL SO t ft FOUNDATION_ft PROPERTY LINE tS ft O FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft O MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL fft JOUNDATION ft PROPERTY LINE ft Yrs SUMPS WIDTH .1 ft LENGTH ft DEPTH 10 r ft DISTANCE TO NEAREST WELL Tft FOUNDATION fa ft PROPERTY LINE C~I ft 0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft O SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION 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,, 24HO__UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED 4-br TITLE _ [-,�SYI, ( C G{'(� �' DATE r �t E� b. L ' r I . 1Z' . Z' l ti DRIPAR.TMENT U E ONVY Application Accept Date Area Employee 1D# •l Final Inspection By Date ❑ SPECIAL PERMIT-Approved by Character of Soil t of 3 Ft: Pit/ ump Soil Character: COMMENTS o -2- PE PE SC Received Ch Amount Date Permit/ Invoice# Permit ID# Code INFO B ash Remitted Service Request# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 1014107