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L ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 301E WEBER AVE-3-FT-STOCKTON CA 95202 -(209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED JOBADDRESR -� -.1 r } % Lu_'� `. G CFrY/ZIP -. 'c r LCROSS STREET p APN 1y1 r - C I - PARCEL$IZE '1I OWNER NAME � ', 1 i-� _) PHONE .1 ..PI 1 J -� OWNERADORESE UI T' �_ ) Irl • CITY/SfATVZIP Y {.._ 71,� V CONTRACTOR I- CONTRACTORADDRESS CITY/STATUZIP LICENSE 0 C4 ❑C-36 OTHER NUMBER E%PIMTIONDATE ` WATERTABLEDEPTH: fl GEOGMPHICALINFORMATION: CDerdlnetef X Y P PERC TEST p BUILDING PERMIT# LANG USE APPLICATION# n C'i- TYPE OF WORK: ❑ NEWWN ALWTION LIREPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER L NUMBER OF LIVING UNITS: NUMBER Of BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTICTANK TYPE/MFG CAPACITY ¢81 #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY Sol #OFCOMPARTMENTS ❑ PKG TX PLANT DISTANCETONEAKEST: WELL ft FOUNDATION fl PROPERTY LINE fl 1 - ❑ LIFTSTATION Sim TYPEOFPuMP ❑ SAND OIL SEPARATOR(EHcImSED Svm.) EL ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLINES LENGTH DFLINES fl DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE fl L ❑ FILTER BED WIDTH ft LENGTH IT DEPTH ft DISTANCE TD NEAREST WELL R FOUNDATION R PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH B DEPTH ft DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE B ❑ SUMPS WIDTH R I.ENQTN fl DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE fl ❑ DISPOSAL PONDS WIDTH fl LENGTH ft DEPTH It ' DISTANCETONEARF3f WELL fl FOUNDATION D PROPERTY LINE ft ❑ SEEPAGE PITS NUMBeR W1DTx ft DEPTH fl DISGNCETONEAREST WELL IT FOUNDATION R PROPERTY LINE fl ` 1 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. MINDBdw4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(3091 95 3-769 7 l 6. BIGNED'v.. I h. e - TITLE ._ `. L.--_'� DAT¢.- •( .` 1 ( 6. I 1 lizPVT ut I " 1 1 - ... FJ IVII Op Im Tn A i lift DEPARTMENT USE ONLY - ApplinTion Accepted By — "' '---- Date v 1-21,/6 w A. EmplOycIc IDN - FinallmpeclioRBy Data ❑ SPECIAL PERMIT-Appmvd by Character of Soil l9 Depth of 3 Ft PIVSpmp Soil Chaneter: COMMENTS L PE SC Rece M Chechpl Amount Date Permitl Invoke# Permit Im Cade INFO B Cnsh Remi.etl Bervke ueat# tr: �: Sz _ 11T'l l L! d rl� �lr i''Lj-•� 's 42M-001 ONSITE W ASTEW&TER PERMIT IVM003