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f ONSITE-WASTEWATER TREATMENT SYSTEM'-qIlERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL :TH DEPARTMENT 600 E MAIN S -STOCKTON CA 96202-(209)466-3420 NON-REFUNDABLE PERMIT �yCALL{209}953-7697 FOR INSPECTIONS EXPIRES ,Y}EARFgROM DATE ISSUED JOB ADDRESS % 90 )CrrY121P f 'IO 7 Z) w { 11 V CROSS STREET f- ie- Qr" 4/� APN D�j'2-,JV-/2,/3 PARCEL SIZE �Oy OWNERNAME �^�/�� r/T�01J�r PHONE /� �P ll16.D OWNER ADDRESS r-3� 6 gyp`�S Crry1STATI!ZIP _-TZ�SZ" CONTRACTOR 1 1✓ V�r PHONE r (04../7 I CONTRACTOR ADDR:Ess a•�/1 �W„ ,T CITYISTATFJZIP LICENSE ❑C42 ❑C-36 OTHER NUMBER EZPIRATION DATE . W TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION TYPE OF WORK:. ❑ NEW INSTALLATION ❑ RE A uRJADorwN ❑ ENGINEER DESIGNEDIALTERNATIVE I ❑ REPLACEMENT ❑ DESTRUCTION 7I INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: Q SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS Q GREASE TRAP TYPFJMFG CAPACITY . gal #OF COMPARTMENTS DwrANCETONEAREST: WELL ft FOUNDATION ft PROPERTY LINE $ i Q LIFTSTATION SIZE TYPE OF PUMP Q PKGTXPLANT t7 SAND OIL SEPARATOR(ENCLOSED SYSTEM) I I Q LEACH LINES 13 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE'rO NEAREST WELL fl FOUNDATION ft PROPERTY LINE a Q FILTER BED Mparw ft LENGTH ft DEPTH fl DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft �- Q MOUNDED W13TN ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft Q SUMPS WIM ft LENGTH R DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 13 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft (� DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTYLINE ft I Q SEEPAGE PITS NUMBER WIDTH ft DEPTH ft INSTANCE TO NEAREST WELL fl FOUNDATION ft. PROPERTY LINE ft ' l HEREBY CERTIFY THAI 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. M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE (M)953-7897 SIGNED TITLE DATE i ME.IVT T D P i i s-F 1 DEPARTMENT V E O LY L!� Application Accepted By Date 6e D - r! Area Emp"a ID# s3(t'U T g� Final Inspection BY Data 6 2f ❑ SPECIAL PERMIT-Approvad by Character of Soil to Depth f 3 Ft: Plus Ump Soil Char-M : COMMENTS } PE SC Received Ch Amount Permit/ Cote INFO B Gash Remitted Cate Service'R Uest# Invoice# Permit ID# i 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 1014107