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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)466+9420 NON-REFUNDABLE PERMIT CALL 209 953-76971FFOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 2311#(84 23-FW 5• MAvuT ECA " •I- CITY/LP MfNNTECA 9533'4- CROSS STREET W RI POI..I Rb . APN 2264-IID '35- * > PARCEL SIZE Z0 Ac• y • OWNER NAME MhtGhR1ET Q. IRoDDAn) E.TRL• �J PHONE (DID' OWNER ADDRESS Z3 TSs S • MAAnZCA CIrviSTATEZP MANiVECPt .CA 9533 CONTRACTOR L-t%16 O/P/IA CTE.UE�nyK 1VIRa�+�'''�tNf+'t L. PHONE lbfI. SC CONTRACTOR ADDRESS O^L�'F W` t/r` gTZp' CITY/STATEP t•`�D�t L� 1 r 2'T D LICENSE QC-42 QC-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: it GEOGRAPHICALINFORMATION: Coordinates X Y 3L PERC TEST # 2 BUILDING PERMIT# LAND USE APPLICATION# A- ' i t TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACT7 gal #OFCOMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS DISTANCETONEAREST: WELL R FOUNDATION It PROPERTY LINE ft O LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ___.. _..... ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES it DR;TANCETONEAREST WELL R FOUNDATION ft PROPERTYUNE it ❑ FILTER BED WIDTH it LENGTH ft DEPTH it DISTANCE To NEAREST MU. R FOUNDATION it PROPERTYLINE it ❑ MOUNDED WIDTH it LENGTH It DEPTH it DISTANCE TO NEAREST WELLit FOUNDATION ft PROPERTYUNE ft ❑ SUMPS WIDTH it LENGTH it DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTY LINE R ❑ DISPOSAL PONDS WIDTH It LENGTH it DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE R • O SEEPAGE PITS NUMBER WImH it DEFrH it DISTANCE TO NEAREST WELL it FOUNDATION R PROPERTY LINE it 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. ,2414;01101111 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TTII'TLLEE L#N5VL.T191JT DATE 3 - 11- 1 Cj jq� Oro"C cj Y ry' Lli NW.V W9[%IVNI nL� 1 >s= . vax-1m,..er�r= DEPARTME T � Application Accepted By Data L Area Employee ID# S Final Inspection By Dale ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: • COMMENTS PE SC I Received z hec Amounl Data PermlU Invoice# Permit lD# Code INFO B CBSh Remi d Service Re est '�3 Ls Ls 4241 nNCITC wnCrFwnTca TFTn.NT cvcTcu ocvurr