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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 NON-REFUNDABLE PERMIT nCALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JoBADDRESS 50 Al-T�LWK. caygiP kc RyK?o 7�7 (= CROSS STREET �J W 0 01>1.7�/t�-1� DCrt• APN/�0 13^1 8 0-��}c S\`I l�1 52-PARCELS..'I� /,,G4Cl� OWNERNAME (Kch.) 1MGI� Npits CnI09-Tm iro OLTy VI�1ENA_R-0S)PHONE (gT 1 V/D Z' OWNER ADDRESS I V{J , FI 7"�!!. CRY/STATE21P R)PIN c-A -153(,4 w CONTRACTOR I+tyEuLoA� G-EO'E�`JI�+�rx ,�i_PHONE 3L91 CONTRACTOR ADDRESS T 0 W' OA WV— S.T. CITY/STAT'ElZIP `O✓ G 5-2-'+0 LICENSE QC-42 QC-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUiLDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: i] NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE O REPLACEMENT U DESTRUCTION INSTALLATION WILL SERVE: ❑ RESmeicE ❑ COMMERgAL FJ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS' NUMBER OF EMPLOYEES' ❑ SEPTICTANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST- WELL ft .FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE R CI MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH It DEPTH It DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE To NEAREST WELL R FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 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. INIMU UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 '? SIGNED TITLE C4PJA> .rdN-T DATE S 7 C ��aOT I eE i � PAREL'Z. 04 7 PARCEL -s t m . `,Y��Qv1N c s! ". n�.z .„.. mar .vrx• DEPARTMENT USE ONLY Application Accepted By Date Area Employee 10# Final Inspection By Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: PiUSump Soil Character. COMMENTS PE 'SC Received hec Amount Permit/Code ”INFO Remitted Data Service Request# Invoice# Permit ID# 23�1D 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 1014107