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L- • ONf�pC�p q GA It p 11 ;�^I�I� r�I��i ��f��p p�� fry � n�r� SFE L E PlVAS u ��V�IY li LrmR � II'�aEA L IICfuL�L'":l � S It S V L N]i !r"IS:fi t�PO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 7868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 1 c�U3 7O d-r*x--,s CITYIZIP L- S 1 s2gc H CROSS STREET C7'Z'AN xl� Z�> APN- CS 1`'f ZC�O `7 PARCEL SIZE zzo - C OWNER NAME RAI►'I OYJ CSoRez ZPt, Z=L=ojVA L'S��/rRZft, PHONE OWNER ADDRESS SRM E- CITYISTAT((E/ZIP CONTRACTORS e'0n4::T(z"CTwr.I SC-Q�C� SNC, PHONE i_�IIQ� L{1 ri_e24SS c� � CONTRACTOR ADDRESS x577 lhbLZRSSoAJ C REE" 11>Z Si'Je-- 200, CITY/STATE/ZIP 5;+CR /S$ R-6XrV C,4 r2 LICENSE ❑M--42 ❑❑C-36 OTHER NUMBER 922y1-G- EXPIRATION DATE CQL3 b/ 2 O 2- WATER WATER I ABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PF_RC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION U REPAIR/ADDITION U ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION 11 INSTALLATION WILL SERVE: VRESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: J NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: lhl SEPTIC TANK TYPEIMFG L'D/U L �� L CAPACITY V600 gal #OF COMPARTMENTS Q- -0 GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ® LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES e LEACHING CHAMBERS J;i 'ArrrR,+i-e 2 #OF LINES 3 LENGTH OF LINES 55 ft DISTANCE TO NEAREST WELL 75V' +- ft FOUNDATION 10' -! ft PROPERTY LINE .30 O� ft Ci FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft C� MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ® SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft -- PROPERTY LINE ft GI DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft rl/"SEEPAGEPITS NUMBER .3 WIDTH y2ft DEPTH 25� ft DISTANCE TO NEAREST WELL -700'+- ft FOUNDATION 80 ft PROPERTY LINE 3 Ho' 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 OHM/0-ADVANCE NOTICE RE Q.6RED FOR INSPECTIONS - PL.EFASE CALL (,09)953-7697 SIGNED TITLE ,�(��zD�rl/� DATE O A IN O 0 DEPARTMENT,USE ONLY I� Application Accepted By Date Area Employee ID# Final Inspection By Date19K ❑ SPE LL i fir. IT-Approved by Character of Soli to De i of 3 Ft: itfSump Soil Character: COMMENTS PE SC Received Check Amount ®ate Permit/ Invoice# Permit ID# Code INFO By Cash Remitted Service Request# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/24/12