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ONSITE WASTEWATFR TREATMENT SYSTEM PERMIT` SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1 600 E MAIN STREET-STOCKTON C. )2-(209)468-3420 - NON-REFUNDABLE PERMIT CALL 20y 1953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED JOB ADDRESS '33 t,i.`L � (S U S r{a— 2 r--j CITYlzIp 'IS-3 0 1/ . tkei�F CROSSSTREET Vcor NC,.l;S 2 Z�) _ ANN •L-5 S- r L�<,- Z- PARCEL SIZE /' I' o OWNER NAME Ar-i'6. -55i11 PHONE 2li! 321-TyJ' 1 7 OWNER ADDRESS cl, V1 C ilk�� P 1 R L;v -- CITY/STATE/ZIP CONTRACTOR -- .-... - PHONE yi CONTRACTOR ADDRESS CITY/STATEIZIP FiLICENSE O C-42 C-36 OTHER NUMBER - EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y © PERC TEST # BUILDING PERMIT#_p'7o2fi�.� LAND USE APPLICATION# Fj TYPE OF WORK: NEw INSTALLATION E) REPAiWADDITION L1 ENGINEER DESIGNED/ALTERNATIVE ,1 0 REPLACEMENT I3 DESTRUCTION INSTALLATION WILL SERVE: 0 RESIDENCE O COMMERCIALDrHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: UMBER OF EMPLOYEES: `e�^� SEPTICTANK TYPE/MFO CAPACITY o p gal #OF COMPARTMENTS R #i Q GREASE TRAP TYPEJMFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LINE ft F, 0 LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) { 16 LEACH LINES 0 LEACHING CHAMBERS #OF LINES crL LENGTH OF LINES f DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LING R F,i U FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE f1 E O MOUNDED WIDTH ft LENGTH ft DEPTH ft DIST CET�NT WELL •OUNDATIO ft O RTYLINESUMPS W TH 11 LENGTH Z ft DD] ANCET WELL ft FO ATION ft PRO ERT E ft - C11; DISPOSAL PONDS w ft LExGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I Q SEEPAGE PITS NUMBER WIDTH ft DEPTH 11 DISTANCE TO NEAREST WELL ft FOUNDATION fi PROPERTY LINE ft F 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. MINNIM OUR ADVANCE TICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE CA DATE J —j 2L 7' sY t i , �I J Ri _ I kip iXDL— J h P-W I �i ul o EN IR N 900 F gt-:—' DEPARTMENT U E O LY C'- Application Accepted By // ) Area Employee li)# C��SFinal Inspection By to l! 0 SPECIAL PERMIT-Approved by ��(```��''' Character of Soil to pthoit/S mp Soil Character- kI COMMS TS A 18 L-L' L—&—4,` J2 P�—Q FJI ' PE SC Received Check#! Amount Permit/ Date Invoice# Permit IDN Code IxFD BY e emitted Service Request# Lf 2-13 if'-7 41 F1 42-01 - ONSITE WASTEWATER PERMIT