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I ' ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> -SAN J04.9UIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868E.HAZELTOII AVENUE-STOCKTON CA 96205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS/ EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS _-J.111LJ^�� CIrwZPn <br /> (� w <br /> CROSS STREET1�`-� APN...�,_(_/D�O_l PARCELSQE <br /> ,c J� <br /> ' OWNER NAME_K.��.�r„L-1./�._ _�._T __PHONE <br /> —:I a- 116 <br /> OWNER ADDRESS Tia t2li d 1% IT"-.J __QTWSTATETP(�)+• "4'� "�4 <br /> CONTRACTOR y—o.,��_/_�2.��=,�rSK�+eC[[ Gat--- __.._PHONE_ <br /> ' CONTRACTOP ADDRESS -t=-7-&--)A _.__�y._�__. CRY/STATE/ZIP <br /> LICENSE ❑1C-42 El C46 OTHER— NUMBER_G EXPIRATION DATE_ r IS <br /> WATER TABLE DEPTH: _R GEOGRAPHICAL INFORMATION: COONIInatae X Y <br /> ' ❑ PERC TEST # BUILDING PERMIT,#,,__-----__,_____LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR <br /> ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: [LRESIDENCE Il COMMERCIAL I? OTHER <br /> NUMBER OF LIVING UNITS: ( NUMBER OF BEDROOMS:_ _ _ NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPAC..oY _ Dal MCFCOMPARTMENTS <br /> ❑ GREASETRAP TYPFJMFG —_ CAPACITY __ Dal NOFCOMPARTMENTS <br /> DISTANCETO NEAREST: WELL II FOUNDATION___„_ It PROPERTY LINE it <br /> ❑ LIFTSTATION SIZE ._TYPE OF PUMP_-_. ..... ❑ PKGTXPLANT Q SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> g/LEACH LINES LEACHING CHAMBERS NOF LINES_2 LENGTHOFLINES41 It <br /> DISTANCE TO NEAREST WELL /' tl FNINnATION_ �-�It PROPERTY LINE 7.3 =It <br /> ❑ FILTER BED Wlmx it LENGTH N DEPTHI It <br /> DISTANCE TO NEAREST WELL_.._.,. . it 'CUPInAlION_ _N PROPERTY LINE It <br /> ❑ MOUNDED WIDTH it LENGTH_... ..--. ___R DePTH - L.:i R <br /> DISTANCE TO NEAREST WELL_-_._ It FOUNUAIION __-------it PROPERTYUNE. It <br /> ❑ SUMPS WIDTH It LENGTH_ _ _ fl DEPni— It <br /> DISTANCE TO NEAREST WELL _ It FOUNUArION t! PBOPERTYTINE N <br /> ❑ DISPOSAL PONDS Wlmx _it LENGTH__ _____ _ _-.—ft DEPTH _It <br /> DISTANCETO NEAREST WELL It FOUNOMION — it PNOPEmYILINEit <br /> ' SEEPAGE PITS NUMBERS...— WIDTH _3G-I[___..— II Du'Ni� It <br /> --- DISTANCE TO NEAREST WELLY 71 1! FOIINDAiIDN --�1°a!}'_torr- It PROPERTY LINE • L - I It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> ' JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 24 Hgr ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CAL 209 953-7697 <br /> ' SIGNED - _ _--.___-_.._ TITLE..G1 n� �.-..__ DATE 'l <br /> Y <br /> J o' <br /> _- <br /> DEPART M ��So�Application AcceptedArea CtF 4!� Employee IDNFinal Inspection By[� yCI SPECIALPERMIT-APPmved by <br /> Character of Soil to a th of Ft:_____. IUSUl p Soil Character: <br /> COMMENTS 7� <br /> gol <br /> SC Received Check Amount ;rtePermlU Inveleeq Permit IDN <br /> INFO ashRemil dif 7/0 2 <br /> ' l ONSI an WASTEWATER TRTMNT SYSTEM PERMIT <br /> 42-01 <br /> MMtT <br />