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1 am <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTHDEPARTMENT 1868E.HAZELTON AvENUE-STOCKTON CA 95205-(209)458-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)9 -7697PQRINSPEC710N5 EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 0-75-7 CITYMP 4-co., <br /> -oI C• _ C�J 1 �_ J <br /> CROSS STREET _ }✓tv].S}r0. 1"F� APN )7 �'� O' b PARCELSM__LQ•__J Y <br /> OWNER NAME 3L.LG�'L..._. _PHONE____ <br /> OWNERADDRESS _ _.. _. CRY/STATE/ZIP nrj <br /> CONI{1ACTOR_ g1T-QL__YL{�r�G1/'+t. �.. L_/3'•�%r PHONE � /p�49—S0i / <br /> CONTRACTOR AmncaS 13/6 (Jf SO L-1 Or. q�/J CRY/STATE21P_____ <br /> LICENSE ACA2 1,'�,C3B OTHER _... NUMaER�[S/-j EXPIRATION DATE_ . <br /> WATER TABLE DEPTH: N GEOGRAPHICAL INFORMATION: Coordinates <br /> PERC TEST k BUILDING PERMIT#_� 0Q.80 7 _— LAND USE APPLICATION III _ <br /> TYPE OF WORK: NEW INSTALLATION REPAaVADRRION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-0F-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: :I RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LmNG UNITS: /f L <br /> ��/�/ NUMBER OF BEDROOM: NUMBER OF EMPOYEES: <br /> SEPTIC TANK TYPE/MFG WTyy yt[�� P:t CAPACITY .1200 gal MOFCOMPARrMENTS._. . . <br /> ❑ GREASETRAP TYPEIMFG _ CAPACITY_ -----.__._ gal Y OF('.OMPARTMENT$ <br /> / <br /> DISTANCE TO NEAREST. WELL AS R FOUNDATION_(,JN PROPERTY LINE _-25" R <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP O PING TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES X LEACHING CHAMBERS_- - ._ aOF LINESr <br /> LENGTH OF LINES R <br /> DISTANCE TO NEAREST WELLR FOUNDATION �F` ,,��_P_ <br /> y�_R PIiOPEPTY LINE�� II <br /> ❑ FILTER BED WIDTH R LENGTH B DLPrH X <br /> DISTANCE TO NEAREST WELL It FOUNDATION K PROPEHIYUNE it <br /> ❑ MOUNDED WIDTH K LENGTH R DEPTH 8 <br /> DISTANCE TO NEAREST WELL R FOUNMOON it PROPERTY LINE R <br /> ❑ SUMPS WIDTH K LENGTHN DEPTH_ it <br /> DISTANCE TO NEAREST WELL _ It FOUNDATION .. . It PROPERTY LINE R <br /> ❑ DISPOSALPONDS WIDTH R LENGTH K DEPTH it <br /> DISTANCE TO NEAREST WELL K GOUNDATION 11 PROPERTY LINE h <br /> ❑ SEEPAGE PITS NUMRFA Woomi h DEPTH 11 <br /> DISTANCE TO NEAREST WELL N FOUNDATION R PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCOROA NCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE RE UIREO FOR INSPECTIONS-PLEASE ALL(209)953-769 <br /> SIGNED _ TITLE 61 _.. DATE_ .LZ <br /> /O I_ < <br /> I <br /> 3 ' <br /> 0 <br /> T <br /> F - - <br /> I EZ <br /> at <br /> O' <br /> N UI O <br /> #11._ <br /> USE ONLY _. <br /> Application AD c r- - Date �_(_L4— Area Employee lDu_.__. <br /> Final Inspection Dale- �(f� SPECIAL PERMIT-Approved DY <br /> Character of SolI to D Ih of 3 Ft: PI Sump Soil Character: <br /> COMMENTS <br /> PE SC R.W" Che Amount - Parmw <br /> Code INFO B Cash Remitted, Dale Invoice e i Permit IDN <br /> Service Re Meat <br /> gala )i �- <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> an4r2 <br />