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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 CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESSJaXi FD' CITYIZIP CROSS STREET/_}L 6(VJ�( U V}E RC1 _•r p /�APN 2/2—-O'FPD-t 9 PARCEL SIZE OWNERNAME AU3 117 1-1'm{1IT_e/U�_ P A.I�ym][y�il ,,PPHOnN�E.�^c�OS' OWNER ADDRESS MM,^�50 Eb�U'III Rd 1 CIY/STATE/ZIP�1711DOJI.'�id ,ICA ` L4nL0 a' CONTRACTOR Illi>(.111s7TJ A.''I1OL GQ1a1LXLLkw,/�� ,�L• PHONE 2oq • 5W5- (4LAD-5 Q CONTRACTOR ADDRESS �I33 9 A fh MW_TS, (20u.e CITY/STATE/ZIP MiDWS in 1 CA q 5�5 p LICENSE ❑C•42 ❑C46 OTHER NUMBERDIII Ifll EXPIRATION DATE �7J '09 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y F1PERC TEST X BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: D NEW INSTALLATION ] REPAIR/ADDITION L: ENGINEER DESIGNED/ALTERNATIVE C REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS= NUMBER OF BEDROOM$: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPAC!-Y_ _-._-_ 021 #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPAC:TY _ Bal #OF COMPARTMENTS W DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES It DISTANCE TO NEAREST WELL _ It FOUNDATION it PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE R r ❑ SUMPS WIDTH ft LENGTH ft DEPTH It r DISTANCE TO NEAREST WELL _ It FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It m DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft h ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft ' DISTANCE T'0 NEAREST WELL ft FOUNDATION R. PROPERTY LINE ft I U I HEREBY CERTIFY THAT 1 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 IMU 2 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS.PLEASE CALL(209)953-7697 SIGNED P�lL W'L1 A—tib TITLE�`17t'//f f ? DATE /-2 T� LE SA J A UI � M I I DEPARTMENT US7 ONLY Application Accepted B Date f 0,r Area Employee ID# `t7 Final Inspection By Date y7 ❑ SPECIAL PERMrr-Approved 6y Character of Soil to pth of 3 Ft,. it/Sump Soil Character. COMMENTS O ) PE SC Recalved Chec Amount Date Permit/ Invoice M Permit ID# Code INFO B Cash Remitted Service Re uest# 1 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 1014107