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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4684420 <br /> NON-REFUNDABLE PERMIT CALL 209 953.7697FOR INSPECTION PIRES I YEAR FROM DATE ISSUED <br /> JDs ADDRESS q t"2 1 -E N II I Cr�l,11 CRIy 11I�T CITY/LIP �J G �7,- j <br /> CROSS STREET ALAS+�r� 0o APN_fJ-�-��� Wg PPAARR�CEL SIZE 6'1✓ CI Lrr-- c <br /> OWNER NAME GkrP S Voh rJ-I'bnt.^SPA PHONE b-m-d'�eI <br /> OWNER ADDRESS SID A, I CITYISTATEMPry <br /> CONTRACTOR .II Ii. S �4Cry1;e- >!2 )1r_ PHONE LT 5t.� <br /> CONTRACTOR ADDRESS Ass Fcc—LF-�(N .. p��y� C Y/STATEW �/�Y Cn-jII-C--,9 CA 95Tyi <br /> LICENSE QC-42 QC-36 OTHER NUMBER Lon frssy EXPIRATION DATE )�T <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST Y BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: L NEW INSTALLATION ,I REPAIRIADDRION I. ENGINEER DESOGNED/ALTERNATNE <br /> .1 REPLACEMENT I OUT-OFSERVICESEPTICSYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEOROOMs: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPF/MFG 1piL- CAPACITY j.a,^O— gal XOFCOMPARTMENTS--) <br /> O GREASE TRAP TYPE/MFD CAPACITY gal It OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL Ind- N FOUNDATION $ it PROPERTYME IMT, R <br /> ❑ LIFIrSTATION SIZE TYPEOFPUMP O PKGTXPLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACHLINES -1 LEACHING CHAMBERS *O LNEs LENGTHOFLINES R <br /> DISTANCE TO NEAREST WELL K FOUNDATION—ft PROPERTY UNE R <br /> W—FILTER BED WIDTH .3& K LENGTH Z6._C A R DEPTH1 Q II N <br /> DISTANCETONEAREST WELL 1Q1 II FOUNDATION��1 It PROPERTY ONE 1001— R <br /> ❑ MOUNDED WImN N LENGTH R DEPTH fl <br /> DISTANCE TO NEAREST WELLR FOUNDATKN H PROPERTY UNE it <br /> ❑ SUMPS WIDTH R LENGTH It DEPTH N <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY UNE R <br /> ❑ DISPOSALPONDS WIDTH fl LENGTH fl DEPTH M <br /> DISTANCE TO NEAREST WELL N FOUNDATION R PROPERTY INE N <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH It <br /> DLSTANCE TO NEAREST WELL N FOUNDATION 0 PR0P 11TYLNE X <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(2091953-7697 <br /> SIGNED TITLE DATEIID -7 13 <br /> _LT <br /> 1 <br /> H <br /> T <br /> _D <br /> 013 <br /> —1717 TIT M fR S AN J A U OUNTY <br /> TIAL <br /> ii—FFM 11 t 1 1 EA 1 i 1 U E! MFM <br /> Application Accepts PP9 /�•A'I 'Date TM N SElONLY— Area 00Employs!lOk lC o dill <br /> Final InspectionDate 1110" D SPECIAL PERMIT-Approved by <br /> Character of Soil to D of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS C. <br /> PE SC Received Na/ Amount D I PermiU Invoice Y Parmlt IDs <br /> Code (NPO B RemlNed Servlca Rs MNI W <br /> azlb sea 5 39 �sss— 20 <br /> 42.01 ONSITE WASTEWATER TRTMM SYSTEM PERMIT <br /> 4NV12 <br />