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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-1209)468.3420 f <br /> NON-REFUND ERMIT CALL(209)953-76 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED jl <br /> JOB ADDRESS r„J CRVRJP /�e�p <br /> CROSS STREEt' APN V � � —f 6 l_/ -c PARCEL SIZE �' C <br /> OWNER NAME ,�-(,G <br /> PHONE <br /> 12-- <br /> OWNER <br /> L- <br /> OWNER ADDRESS -q6 07 <br /> /(n �jQ PV Ep CINISTATEZP <br /> CONTRACTOR _��,r R I-, I /mss” A5 , PHONE (� <br /> CONTRACTOR ADDRESS 1 CITYISTATWZ 1 <br /> CO n A , ` <br /> LICENSE XC-42 QC-36 OTHER A NUMBER E%PIRATION DATE TR <br /> WATER TABLE DEPTH: t( GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> C PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: n NEW INSTALLATIONREPAWADDITION n ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT 0 OUT-OF.SERVICE SEPTIC SYSTEM 'J DESTRUCTION <br /> INSTALLATION WILL SERVE: L RESIDENCE 0 COMMERCIAL F1 OTHER <br /> NUMBER OF LMNG UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> O GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELLft FOUNDATION ft PROPERTY LINE H <br /> ❑ LIFT STATION SUE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) y, <br /> (3 LEACH LINES LEACHING CHAMBERS - #OF LINES LENGTH OF LINES <br /> DISTANCE To NEAREST WELL ft FOUNDATION it PROPERTY LINE R -Q <br /> 1 <br /> ❑ FILTER BED WIDTH ft LENGTH IT DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> J ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft ` <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 ❑ SUMPS WIDTH ft LENGTH ft DEPTH <br /> 'r`_VITi, <br /> ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> L) DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATiON ft PROPERTY LINE ft Q <br /> SEEPAGE PITS NUMBER W TH ft FOL ftft DEPTH it <br /> DISTANCE TO NEAREST WEL UNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT i HAVE PREPARED THIS APPLICATION AND E WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> TATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MI 4 HOUf �IRED FOR tE {OII�$j i E CALL(209 53j7 -40 <br /> SIGNED vy TITLE v' f _ DATE � t U <br /> � I <br /> i <br /> I p <br /> e <br /> 0 <br /> I <br /> I <br /> A <br /> I <br /> J A <br /> jC EP <br /> `=r <br /> -v---D E P-A-R-TTA E-N-T 5 E'O'N`L•'Y'"_'.�- -=max <br /> r Application Accepted By Date .3//7//0 Area Employee 10# <br /> Final Inspection By 'I' C lJ7i 4) 7J Date 3 D SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PitfsUrnp Soil Character: <br /> COMMENTS Sr9Ec l,ac- QF enc rT 2o.iED /jo 0,,t / s-rA--.1J A-4-4 <br /> -A, 0r¢ -CiOE"AL yl !'r_- 43�o/I'7 71 <br /> CY�ciaSC. IES 1L Zy c%ftl6�✓ 2r <br /> j PE SC Received C Amount Permit/ <br /> Date Invoice# Permit 1D# <br /> Code INFO B ash emitted Service Re oast# <br /> Z 12- (/.5- �f 3 b 230,TO �q -D <br /> /U 5Tp Cttf'7f.i�w�/��y i�2vti7�n12�-�`-s��o " �/mac d/�s/7- 7Bv�rJ7cgf3�i�� G��'7ty <br /> ��"IGG5�57`�?'l;��'f7��=.�.!»vt>r'�'..�S�L✓�j��lCc��S �G (Y:%ZtA.i%G7trA�:.�� <br /> 4228/0£ ; DLf11� �,,,,.,��„l � j/ ((�,�� �j ONSITE WASTEWATER TRTMI�IT SYSTEM PERMIT <br /> 8 <br /> jTGi�� <br />