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� J. ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN <br /> JOAOUINCOUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868E.HAZELTON AVENUE-STOCKTON CA 95205-(209)465.3420 <br /> NOREFUNDALEBPER <br /> N- MIT CALL 209 953-7697 FOR INSPECTIONS E%PIKES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS. AMM ar. v ._GlTYlZP�M-..Y+a-a GA y 33 T N <br /> CROSS STREET APN ZZ OAS 1T PARCEL SIZE i p <br /> O <br /> OvmEn NAME 1..4S F•`/ �ILi� PHONE <br /> OWNER Annnass 5r• CRYISTATEIZIP <br /> CONTRACTOR �.•. PHONE <br /> CONTRACTOR ADDRESS _le to t3 na l✓sA _..... CRWSTATEJLP &&A <br /> LICENSE _C.42 I;C-36 OTHER E'/� NUMBER SFq_EKPmAT oN DATE�T/ <br /> WATER TABLE DEPTH: 1I GEOGRAPHICALINFORMATION: Coordinate$ X Y <br /> NERC TEST $ BUILDING PERMIT N_ LAND USE APPLICCATION M <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION EN ERDESIGNEDIALTEMMTNB <br /> REPLACEMENT OUT-0F-SERVICE SEPTIC SYSTEM DESTIRICTION <br /> INSTALLATION WILL SERVE: E&DEICE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UMTS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> _/ <br /> Ay SEPTIC TANK TYPEIMFG D1-L CAPACITY ,7 AA gel MOFCOMPARTMENTS�l <br /> ❑ GREASETRAP TYPE/MPDCAPACITY gal SOFCOMPARTMEN1T.S. <br /> DSTANCETONEAIEST: WELL �y� K FOUNDATION tai I1 PnoPERTYLINE In N <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> a LEACH LINES LEACHING CHAMBERS YOPLINES LENGTHOFUNES SOI R <br /> DSTANCETONEAREST WELL_jn-t it FOUNOATON to R PROPERTYUNE rA� R <br /> O FILTER BED WIOTX R LENGTH______ft DEPTH R <br /> DISTANCE TO NEAREST WE _11 R FOUNDATION H PROPERTYUNE R <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION it PROPERTYUNE B <br /> ❑ SUMPS Wmrx R LENGTH R DEPTH R <br /> DISTANCE TO MEANEST WELL R FOUNDATION It PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH_ K LENGTH R DEPTH N <br /> DISTANCE TO NEAREST WELL H FOUNDATION R PROPERTYUNE R <br /> ❑ SEEPAGE PITS Nua$ER WIDTx R DEPTH N <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PFOPEPTYUNE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES ANO REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOURDVANCE NOTICE REQUIRED FOR INSPECTIONS��I4 CTIONS-PLEASE CALL 209 953-769 <br /> 97 <br /> SIGNED ATITLE "LR%ItO r DATE A I (I <br /> O <br /> ( O C <br /> NLY _ <br /> Application Accepted By L- - Data _LI Area oY Employee IDB �4S•`✓/-1.(c) <br /> Final Inspection BY • I ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft P USump Soil Character: <br /> COMMENTS <br /> �y a i,e 6 <br /> PE SC Received ec Amount is Permit/ Invokaa permit IDB <br /> Code INFO B $ Remitted Service fl ueaH <br /> 211 It S' 2 Lq 0 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4124112 <br />