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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALT DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)438-3420 <br /> NON-REFUNDABLE PERMIT ��lj� �NJ CALL 209 953.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS (�7/ E• Y( hyfANH„N ZAwe CmITJP L-./_• 5S"?50 12 <br /> CROSS STREET{ AVE - APN 049-23'D-LI PARCELSME <br /> Al CG• P2 <br /> OWNERNAME DGifn wiij PHONE 3ZI 4SS/ <br /> OWNER ADDRESS CTWSTATEIZIP <br /> CONTRACTOR l w A/ t/19//may )n�C.- 9 PHONE -3&f-S�OZ7 <br /> CONTRACTOR AOOREBa ."x!'10 ;&,WAC 1.2w2 CITWSTAA,71P Z/' ZA. <br /> LICENSE 0-42 UC-M OTHER NUMBER 4S5n5FS' EXPIRATION DATE 67-!3/-1Q <br /> WATMT TABU DEPTH: R GEOGRAPNICAL INFORMATION: COMOIIIabS X Y <br /> ❑ PERC TEST • BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADDITION ❑ ENGWEER DESIGNED IALTEHNATIVE <br /> ❑ REPLACEMENT ❑ OUTOP$ERVICESEPTICSTSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> NURSER OFLMNO UNITS: lJ NUMBER OF BEDROOMS: NUMBER OF EYKOYEES: R <br /> O SEPTIC TANK TWE/MFG 40✓.A" CAPACITY 3000 gal #OFCOMPARTMENTS 7 <br /> Q GREASE TRAP TYPEIMFG CAPACITY gal #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE R (®�' <br /> O LIFT STATION SQT TYPEOFPUMP 0 PKGTXPLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) `- <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES 40 ft m <br /> DISTANCE TO NEAREST WELL ZLS, it FOUNOIITION _ft PROPERTYLINE /QO- R <br /> O FILTER BED WIDTN - ft LENGTH It DEPTH ft <br /> DISTANCETONPAREST WELL ft FOL#AATION ft PROPERT'LINE R (T <br /> O MOUNDED Worm ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL TI FOUNDATION R PROPERTY UNE ft <br /> Q SUMPS YRoTH ft LENGTH ft DEPT ft 11., <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft i <br /> O DISPOSALPONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl Z <br /> 0 SEEPAGE PITS NUMBEyT <br /> R 6 WImH 34" ft DEPT ,7$, ft <br /> DISTANCE TO NEAREST <br /> �WELL7./AWS. -fl_,FOUNDATION ,.AA' • ft PROPERTf UNE JCbt` ft <br /> I HERESY 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 JGROWN COUNTY. ' <br /> MINI 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED TME DATE 4-7'/6 <br /> N <br /> ,IN ry <br /> 0 4T <br /> ,i. <br /> M <br /> I <br /> w O D 1 <br /> P <br /> I <br /> I <br /> DE P ARTM ENTU EONLY <br /> rte. _ .....�..+- <br /> APPnc.Bon ADrApt��S� � asa E,npayaB ID#-S4 EF'f 49 <br /> Final llMpsttlon By Dab 9/ ❑ SPECIAL PERMIT-AMovad by <br /> ChaaT of Soil b of 3 Ft: PIU <br /> bctSump Sol[ChamcW: _ <br /> COMMENTS NEW E-17—;,Y= 41E71.AA <br /> PE SC Recelved Ch Amaulrt Dffie ParmlV ITWoilx# Parmft lDB <br /> Coda INFO B ash III Service neat# <br /> I <br /> r 42dt <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />