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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 CALL 209 953-7697 FOR INSPECTIONS ExPPIRES'I YEAR FROM DATE ISSUED JOB ADDRESS I,5-4(o-+ /c- KI✓n-.gy r\j LTJ • CITYIZIP LOT>I tel, 7-40 N :a A_ � CROSS STREET T V L Ly APN ()S;3 U 0 p O- z 0 PARCEL SIZE 1 q 1 Ac . > b OWNER NAME DVS I&H-T 'DVSA LA CC I-1 I �y ^ PHONE Q vi OWNER ADDRESS 9O-4S W L—f}ND 1`,J' CITY/STATEIZIP L-domilS CA ft-&YDf CONTRACTOR L•1 VL O,LLT^V- lT7iV F.pN.�'��N VH F./�N�L PHONE 3 VI -03� CONTRACTOR ADDRESS Q-I W, 0 S7- CITY/STATE/ZIP L-4ybI C}�` c?SZ40 LICENSE _.C-42 C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # FIBUILDING PERMIT# LAND USE APPLICATION# -I(P 0 0 7-0 0 TYPE OF WORK: NEW INSTALLATION REPAWADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: 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 1 1 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ®� ❑ MOUNDED WIDTH ft LENGTH ft DEPTH =R4E DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE '�•�- ❑ SUMPS WIDTH ft LENGTH ft DEPTH /IiI/1 Aft O DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft, ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ftO,O DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE Csy v ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH Tti My Fou, , DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, SENT STATE LAWS AND RULES AND REGULATIONS�OF SAN JOAQUIN COUNTY. INWU/y/tPHOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 G SIGNED / /a`' l TITLE G o t14vt:T/i N r DATE '3 �' IIIIIIIIIIIIIIIIIIIIIIIII' � �-� � _ - — [ 0000 I L i I __ i -fi ------ -"'�------ _ ---- --I - - _--------- te Lo I — --- ------------ OVERALL SITE PIAN FrAUM SITE PLAN rD AR ME T ON Application Accepted By ate / Area Employee ID# Final Inspection By Date % SPE CI L PERMIT-Approved by Character of Soil to D p of 3 Ft: iVSu p Soil Character: COMMENTS PE SC Received Chec Amount Permit/ Code INFO B ash mitted Date a Service Re,ru�est# Invoice# Permit ID# g2_pt ONSITE WASTEWATER TRTMNT SYSTEM PERMIT