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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 /�C y� SCALL 209 953-7697 FOR INSPECTIONS VEXPIRES 1 YEAR FROM DATE ISSUED r JOB ADDRESS SoZ3 e /lJ!r�G'� `ISI- CITY/ZIP STUVr"TpN _/•� 11 Z 2-11 7 y � CROSS STREET P—yFImo- APN O4�— 0� PARCELSIZE 2 -(�11 > O OWNER NAME T311�`�-- V`-•' I '-I y�� p cif PHONE �,.'-^I 1 GZ� OWNER ADDRESS 2go7.—+ Vj'/fC,V_&V-1> r�'��•..r�y� CITY/STATE/ZIP S VC-I••L��, CA I�ZD(r CONTRACTOR Li�/`�'/t Or r` Vf-OV`�VI R'OrJME4y 1 �1 " PHONE 3&1- 03-7-5 CONTRACTOR ADDRESS 4o-j- W• ome- s7-. CITY/STATE/ZIP Lot ( 4�A qSJ 40 LICENSE L.0-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # 'L BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: C NEW INSTALLATION ❑ REPAIR/ADDITION i_ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE E COMMERCIAL F 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) A ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ��•„� DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft c �® DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE w ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It G/ Q DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE V ✓C I( . ❑ SUMPS WIDTH ft LENGTH ft DEPTH HL.�I�I/D'Siz, COUA']� DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE N ENT,q�V ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER 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. MINIMUM UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE (,V-r4V1,TYW r- DATE D DEPARTMENT U E L Application Accepted B ate Area Employee ID# Final Inspection By Date4A ❑ SPEC AL PERMIT-Approved by Character of Soil to D. 'th of 3 Ft: � Pit/Sump Soil Character: COMMENTS I Cit �LO�f� M/lL / YL Test I41)ro 2 — MI•66 Win, j►rl- PE SC Received Check Amount Date Permit/ Invoice# Permit ID# Code INFO By s lernilel Service Re uest# Z 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT