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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 t NON-REFUNDABLE PERMIT CALL 209 9$3-7697 FOR INSPECTIONS�L EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 6 w' S-rVc4e_-ry^J 9-T' -CITY/ZIP /TIO� I�N 11�O 4, ,Q� CROSS STREET SrtC0AwlE�b APN oo I ` /_/0- -43 PARCELSIZE Ar. p OWNER NAME FIiE1� F4')"U7"h^j PHONE OWNER ADDRESS �r" O OA 40 I �N+bD ✓^' CITY/STATE/ZIP 5A^j jo3E CONTRACTOR ` OAr— &f_oEN✓IRONn'ItnrFAL_ PHONE 2'*'? 9-o375' .1 CONTRACTOR ADDRESS 4o4 w - 0 S-F. CITY/STATE/ZIP ( LICENSE ._C-42 C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST I FBUILDING PERMIT# LAND USE APPLICATION# PA 6�OfJU } TYPE OF WORK: ❑ NEW INSTALLATION I I REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE I.I REPLACEMENT LI DESTRUCTION INSTALLATION WILL SERVE: -1 RESIDENCE I COMMERCIAL I 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 It FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES I I LEACHING CHAMBERS #OF LINES LENGTH OF LINES DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ FILTER BED WIDTH ft LENGTH It DEPTH 1 ^ y DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft `V r•a OV` ❑ MOUNDED WIDTH ft LENGTH R DEPTH ft P '4V DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft SON^ VOCL�_Q'C ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft ��V`ia�i", DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION It 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. MINIMUM 22y2 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 G SIGNED TITLE Cd'1JS�'LTY��'7� DATE II o / III \ m III I o ui IIII .oreot � m A.P.N. 001-190-45 III 4.5 0 I ,99'L9L II \�—�--k IV`I Z m EX.SEPTIC EX. SEPTIC 1 $ \ \ �- III rn III ,00.091 C M 4 III O c� \ I m III 8 A.P.N. 001-190-44 11 oI Z J S s I m III Sz.091 EPARTMENT U E QN Application Accepted y ate Area Employee ID# Final Inspection By Date SPEC Al PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Cha act r: COMMENTS �C� �� ✓ tz - S �L�,✓��.-n<<j PE Sc Received / Amount Permit/Code INFO ' Cash miffed Date Service R uest# Invoice# Permit ID# 1-73 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT