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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 • wCALL(209)953-7697 FOR INSPECTIONS ExPIRESq' YEAR FROM DATE ISSUED JOB ADDRESS eALMaOST- AVE . CITY/ZIP Iy'r" Q- cye CROSS STREET 7••r'f C, (�P-- APN Z�� 0-)0 -v-T PARCEL SIZE 0'y r—• tj OWNER NAME m(�'"' `�` m t� PHONE rmi, OWNER ADDRESS �C� 1 o • INt � )-'� CITY/STATEIZIP TI`�1�'l CONTRACTOR LIYI-LLLLO U"�DI=A,N'V'yI2pNM�V-(ftL PHONE 3t09-p37S T CONTRACTOR ADDRESS o-) Ii. DAV— ST-. CITY/STATEIZIP L-Oa( CA 457;"'o LICENSE I C-42 IC-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: ._ NEW INSTALLATION I I REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT II DESTRUCTION INSTALLATION WILL SERVE: 1 RESIDENCE I 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 It FOUNDATION ft PROPERTY LINE ft ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH ft LENGTH It DEPTH It DISTANCE TO NEAREST WELL It 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 It DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It ❑ 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, `A-AAw� STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. \j/�,�� MINIMUM 24 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 / `` SIGNED �i/ C�/.�, /V TITLE �. ✓L 1°INT DATE RoN�No 419 c � 714 I� ? % EPARTME ON Application Accepted Date Area Employee ID#4 Final Inspection By Date SPECIIT-Approved by r Character of Soil t epth of 3 Ft: Pit/Sump Soil Character: COMMENTS 3 VV,�A lr{t Lk PE SC Received C Amount Permit/ Code INFO By, ash jernitted Date Service Request# Invoice# Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT