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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 nCA 7LL 209 9953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED • JOB ADDRESS {��-��0/S 7� /•) Q13,QP- /►N t.+T /ten CITY/ZIP L04-4c - )Z� 9Sz3 (,t}� =y CROSS STREET 1 I f u-/, '`/ "'j"�'7 /./APN os I -L-3 '�/0 ARCEL SIZE •'` tj OWNERNAME r0CONS '�'"V'C-I��('��.�/�( NIL JOAIE�' jzzx PHONE 3-33-I I 1 OWNER ADDRESS J/�L�-- +,' r ,NSC > ' •/J 7Z CI ATE/ZIP I_�-^'G�),^�C�` LI�Z40 CONTRACTOR L4VE [[O``Y-- C7 C-t7 E�NvV ``L�Nmfi�`� I \ PHONE C? CONTRACTOR ADDRESS 'TU VI)' UI`� S�' CIN/STATE/ZIP LICENSE C-42 C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # ( BUILDING PERMIT# LAND USE APPLICATION# P A- > TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: I RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG 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 LENGTH OF LINES ft DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE :Nl LISUMPS WIDTH ft LENGTH ft DEPTH ' cF �iyr DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE //ft�. 1- ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTHN[/1 FO DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ✓QwI[ �O,D DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE 6N vQ I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINAN �FA STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. �M�INIM��}//}N1N''�24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED �d"� I Ives TITLE C OivSVL I/`ANT DATE E SITE EPARTMENT SE LY4 n ,•// Application Accepted By Date d ` Area "L Employee ID# W� Final Inspection By Date)/4-Y/4' � SPECIAL PERMIT-Approved by Character of Soil to Dep of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Received eck Amount Date Permit/ Invoice# Permit ID# Code INFO Ely ash RemittedervicsRequest# 4242�-54 I ) S" IMI 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT