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Lft_fJ11) V'ASlLI fhRAnI SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION ( 304 E.WEBER AVE 3"FLOOR.STOCXTON,CA 952D2(209)46R-3420 `I //'�; (, 1) / ,^ NON. )AB E PERMIT EXPIRES I VEEAR FROM DATE I SVED /,,1y JOB ADDRESS,�[ / 3O�` /`A1�Jl�l f l' Y� ,,� APN ) Il��1 Y9' PARCEL SIZE:33,(1 t� CITY/ZIP Lk1 1 r MBUILDING PERMIT N0 I (.V� ) OWNER NAE C � Ir ADDRESS 10 1 ` MI< I7- 6,1 1 r CITY/Z1P 1 1 /�•, 1 1 � PHONE NUMBER � CONTRACTOR P� �/• �YI��`Y II' �/�� !/ ADDRESS /�/��' 5�1�r �-�0/� CITYIZIP W I I PHONE NUMBER 1?0� S6 7 :3/7 / . GEOGRAPHICAL INFORMATION:COORCINATES:X Y TOWNSHIP RANGE SECTION TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVINGUNITSc i�J\ ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: ❑ REPAIRIADDITION ❑ COMMERCIAL _, __.;gUMBEROF EMPLOYEES: ❑ DESTRUCTION '. ❑ OTHER r - - ZI ENGINEERED/ALTERNATIVE CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: (� PERC TESTS) HOW MANY APPLICATIONS Pf� -0 A 7-77—g- �❑ SEPTIC TANK TYPE/MFG CAPACITY #OFCOMPARTMENTS G ❑ GREASETRAP TYPE'MFG CAPACITY #OF COMPARTMENTS Z ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE: rf'1 Cl LIFT STATION SIZE' - TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) #OF LINES. ` LENGTH OF LINES: ❑ LEACH LINE DISTAncE TO NEAREST. WELL FOUNDATION PROPERTY LINE V INFUTRATOR.CHAMBERS:- ❑ FILTER AX.I) WIDTH LENGTH DEPTH DISTANCETONEARE.ST: WELL FOUNDATION PROPERTY LINE ❑ MOUNDED WIDTH LENGTH DEPTH DISrANCETONEAREST: WELL FOUNDATION PROPERTY LINE ❑ SUMPS WIDTH LENGTH DEPTH DLSTANCETO.NEARLR: WELL FOUNDATION PROPERTY LINE ❑ DISPOSAL PONDS WIDTN LENGTH DEPTH D6TANCITONEARSR: WELL FOUNDATION PROPERTY LINE - ❑ SEEPAGE PITS #_ DIAMETER DfIPTH DI.R.vICETONG6 T R : WELL FOUNDATION PROPERTY LINE :.{ A t 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. M1 NIM1 N 2i HO ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 SIGNED: TITLE:/� DATE: IF- WTF �.JJJJJ �JJJJJJJi�LJJiyJ-IPLAN... a '� %,AMtieaefon• A -O 2 Ob 2 9 8 Cn w" Vii'' �. L WFA*TMWf VSE ONLY D APPLICATION ACCEPTEDBY: V 4.9%`yI V•LW`r'J 1/V'� DATE:.1I rl �. AREA�I n EMI'LdVEc DR DISTRIR_o�LUCATION INSPECTED BY: DATE. PERMIT FINAL YES DATE:NOV 2�, 2 COMMENTS: SAN JOAQUIN COUNTY �NVIRGNMENFCI.NTA = "1S1:.". i. PE CODE SC INFO AMOUNT CHECK ASH I RECEIVED DATE PERMITSERVKE REOVEST+ L VOICE- SEPTIC IDN REMITTED BY li AL 0031 °�8z RevrseD+-Is.ol _ RECOMMENDED SEWAGE DISPOS AREA RECOI D4E NTED SEWAGE DISPOSAL ARFA TEST PERFORMED BY: TEST CERTIFIED BY: o6sE2uc,o