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ONSITE WASTEWATER TREATMENT S YS T ENh PEMOT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDA13LE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED JOB ADDRESS 2 CJ-\j C A�f►Mpo 2t> CITY/ZIP 2.Zo CO) y t� CROSS STREET N, S yCAmoRe 9D APND 13( (o 0C>Z PARCEL SIZE • 3 Y � C �d OWNER NAME /P r4 u EL V t- /f PHONE vh OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR /7 CONSTKVCT1&t7 � ,S'�QTTC, 37i\G, PHONE 1-11'L, L{-]J- ZYS� CONTRACTOR ADDRESS SS77 y7�oRRrS�AV CRL'�Lk 1>0- 5 1--15'200 CITY/STATEIZIP pc�CX,,,,, LICENSE LTLII.-42 ❑0C-36 OTHER NUMBER_/2296, EXPIRATION DATE D S44,3�f WATER 1 ABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: U NEW INSTALLATION REPAIR/ADDITION U ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: .2 NUMBER OF EMPLOYEES: ® SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS 0 GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft n- LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) 0 LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft Q FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑1 MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft el"—SUMPS WIDTH 2 I ft LENGTH .261 61 ft DEPTH O , ft DISTANCE TO NEAREST WELL JV 0 ft FOUNDATION 10 Q5"- ft -- PROPERTY LINE ft Q DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft CI SEEPAGE PITS NUMBER I WIDTH ft DEPTH ft DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 1!/IG 4�tlla laA�� SSP R WrINCt` IVOTIC,E REQUIRED FOR 1AISPECT10iV5 - PLC—ASE CALL (209)953-7697 SIGNED TITLES ��C�S�-J�l�r DATE 0 /t r �—, U 121 1VISON M- .N7AE—F 1- G tr 0 � pF ^ EPARTMENT S ONLY Application Accepted _ Date Area Employee ID#— /C— Final Inspection By Date SP AL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soilaracter: COMMENTS PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO B as Remitted Servi Re uest# 00- WE---aw—) qo j 3co 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/24112