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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DE MENT 68 E.HAZEL.TON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTI EXPIRES YEAR FROM DATE ISSUED <br /> JOB AP6RESS _`� G✓• <br /> CROSS STREI54 R v' 5- AAPN l//_ / [ y `9 PARCEL SIZE <br /> / C <br /> OWNER Ngtafe `O.•S 6�1tTQ� / _ _ PI��Z09175�7 676 T <br /> OWNERADDRFes 2 7�/ �✓• �� _ CITY/STATTE/7AP <br /> CONTRACTOR Z' _ PHOWEE <br /> CONTRACTOR ADDRESS _ —__ _ __. CIT, TATE/ZIP <br /> LICENSE Ll C-42 I I C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X _ _ Y _ <br /> 11 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATiON REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP_ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL F A�I IQ ft PROPERTY LINE ft <br /> L3FILTER BED WIDTHILD IMEL) DEPTH ft <br /> DISTANCE TO NEAREST p <br /> t OU ATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft IL 11,lutve✓ alae w DEPTH ft <br /> DISTANCE TO NEAREST WELL"! T nw-t PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft 1! alitn DEPTH ft <br /> DISTANCE TO NEAREST WELL I ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LE GTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED/ TITL <br /> NIT <br /> J A UN On fAr <br /> E 7- <br /> E T. <br /> II ^ <br /> DEPARTMENT UAE ONLY <br /> Application Accepted By Uvv Date I. JOU10- Area D 4V4'f Employee ID# r1 ALU <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS J E7.4OVit, J trZLw L4 Ste¢= <br /> PE Sc Received Che Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cas Remitted Service Request# <br /> ItOU 0 ��ps 05- <br /> I 11 �' Q07 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />