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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> �. .JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECT/ NS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1 L� rr S( *� CITY21P LA i <br /> C <br /> .1CROSS STREET [ J )bi l e y APN /D� -2-'7 D '"C�� _ PARCEL SIZE 6 <br /> OWNER NAME o Ke- 72G1-0:S <br /> c� C del <br /> r�e� cX^� <br /> OWNER ADDRESS \O-1-I Q C�J�G r G r r CITY/STATEIZIP SCN�"� el Gj Q ! <br /> �( <br /> CONTRACTOR 7C t e _ PHONE -7L " UI 5'd �,5 9 i <br /> CONTRACTOR ADDRESS �f L� _ CITY/STATEIZIP f ACL �v <br /> LICENSE FIC-42 QC-36 OTHER A NUMBER 1/4/77 -EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION 1Z REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> 11 REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: D RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 13 SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> 13 GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 LIFT STATION SIZE TYPE OF PUMP 17 PKG TX PLANT 13 SAND OIL SEPARATOR(ENCLOSED SYSTEMS 4) <br /> N i <br /> 0 LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft I <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> D FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O SUMPS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft 1 t 1 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 SEEPAGE PITS NUMBER WIDTH ft DEPTH 'ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I <br /> i <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. yy <br /> MINIMUM 24 H DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7687 <br /> TITLE C n`4'_CCA 01-- DATE to <br /> e, <br /> `` \} <br /> r <br /> 4 <br /> y <br /> t P J <br /> U <br /> DEPARTMENT US ONLYy. <br /> Application AcCeptQDated . Area Employee ID# *-d.�,../5 <br /> Final Inspection By ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to De th o 3 Ft: PI S mp Soil Character: <br /> CO ENTT fo C o, -5,4 b'_'J� <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> 42-10 11-5- 10NA7 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 10!4!07 <br />