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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 WON-REFUNDABLE PERMIT , d�1 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS (Qd !-9 E• LA 'r'l-0 P X-P. 1 CITY21P MAAMC-A `,S 33�i7 L q � �0 LA CROSS STREET r �✓L D APN 1 1 `09 PARCEL SIZE Jy � - b OWNER NAME CT�11-7 W�N 'S PHONE '4-7 y OWNER ADDRESS` 9"Of v►'1E CITY/STATEIZIP 7 G CONTRACTOR C1✓C oAy— &-C-oc1-)v✓I'-wlVt"En/1 I1 i— PHONE -J IP I 0-7 S .� CONTRACTOR ADDRESS 4/07 r'W. OA" ST' CITYISTATE/ZIP L-00 1 C!1p 6 I S"7,4O LICENSE EIC-42 1IC-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: Il NEW INSTALLATION Ci REPAWADDITION I i ENGINEER DESIGNED/ALTERNATIVE II REPLACEMENT i- DESTRUCTION INSTALLATION WILL SERVE: 1_I 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 ft FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ SUMPS WIDTH ft LENGTH It DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL It 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. MINIMUM R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE C-lo s V(-7 nN T DATE (0 RF Y�ENT CE jV�D s SUN 14 Z019 �AIVI)RAQWN r'eqTNS; EAI-rAL 1Y MENT DEPARTME T E ONkY Application Accepte]p*of3ft: Date Area Employee ID# Final Inspection By (J,� Date 1 $P IAL PERMIT-Approved by Character of Soil to Pit/S mp Soil Character: COMMENTS P1,YC, R utt/ I`5 . �Q Z vY1 i �/;A PE SC Received C Amount Permit/ Code INFO B ash Remitted Date Service Re uest Invoice# Permit ID# L 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT