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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 NON-REFUNDABLE PERMIT /� d CALL /209 953-7697 FOR INSPECTIONS /tom a� �E{XGPI�RESS'I YEA R FROM DATE ISSUED JoB ADDRESS S. �`1 I\N T EUV Xb- CITY/ZIP �r 1 r 1 ivr !L&A ! s-3 3-1 z ,(pep zw-rr�-4u - Y CROSS STREET W r �I f V/ APN PARCEL SRE o OWNER NAME A h,1N4CI i e 'r I C�M r-{/� T� PHONE &w- OWNER ADDRESS z3�POr !Sy'^/Cr,A,nN �L7� �1r ' CITY/STATE/ZIP M^NTr-CPQ CA 9533-+ CONTRACTOR L-I J E O^Y— &-�EroV11r�N IA4 E1V7A I-- PHONE 3"`0 3� CONTRACTOR ADDRESS 40-4 W ' O'Ale- 7T' CITY/STATE/ZIP L-oD( C'A /FZL4 a f LICENSE LIC-42 E]C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # Z BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: " NEW INSTALLATION I i REPAIR/ADDITION I I ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL It 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 LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH It LENGTH ft DEPTH A DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft A`� ❑ MOUNDED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE�/�/�/ ft ❑ SUMPS WIDTH ft LENGTH It DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE Rn, rft y ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH j0,A-ft, DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTHHd(l�yh, DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE "4c 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, FNT STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM,2"OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 q SIGNED /`il TITLE GOA1fVC.�TIf►�T DATE RTI s N 1. WN (-°r rise* _ 041 i<Y i DEPARTM T E N Application Accepted By Date eate- Employee ID# Final Inspection By J',0L Date L SPE IAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS P-e,e fOA-4 A -(04 A^14A 4 PE Sc Received hec Amount Date Permit/ Invoice# Permit ID# Code INFO Bash Remitted Service Re uest# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT