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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENYI RON MENTAL HEALTH DEPARTMENT 304 E WEBER AVE-J"FL-ST'OCKTON CA 95202 - (209)46R-3420 NON-REFUNDABLE PERMIT CALL((209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED L JOB ADDRESS _ CITYIZIP �(o jC Hop CROSS$'TAFFY 1APP`N}��f-2-�O PARCELSIZE •^/ �/'' fop OWNER NAME ,r/Y /''� • CJ �1"C,/.1 Jt-,T _1 / PHONE�.364. `LI/01 -Q y OWNER ADDRESS �V�- (�FEL��1,—, `N E F CITYISTATFJZte�/1� (�Q1�NI`��SY/ `Mr/+V,�_ CONTRACTOR _�`a-a--ts-H I sr+,j� )l.IVr. -(`��-'�PPHH1ONE 466��}��J�JL_/ / CONTRACTOR ADDRESS 4 �/ /W L�ac 'A NY�'! CI"[Yl$TATFIJZIP GJ 1 LJL ALT(/`\1(^/�.1C -(�� LICENSE C42 ❑C-36 OTHER A �,hJ&h1 lNUMBER ��I 1 E%PIRATION DATE tll[_Q�__ WATER TABLE DEPTH: R GEOGRAPHICAL.IN FORMAT ION: Coordinates X Y_ ❑ PERC TEST(S) NUMBER ___ LAND USE.APPLICATION 4 _ TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ EENrNcivEEEERR DisiGNED IALTERN V[ ❑ REPLACEMENT ;ie y� DFRUCTION�,T=J yA" INSTALLATION WILL SERVE: ❑ RESIDENCE JW COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: \ NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPEIMFG_ _ CAPACITY gal 4 OF COMPARTMENTS ❑ GREASE TRAP TYPFJMFG CAPACITY gal 4 OF COMPARTMENTS_ _ ❑ PKC TX PLANT DISTANCE To NEAREST: WELL ft FOUNDATION R PROPERTY LINE tt ❑ LIFT STATION SIZE__ TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS q OF LINES LENGTH OF LINES ti DISTANCE TO NEAREST WELL R FOUNDATION _R PROPERTY LINE R ❑ FILTER BF,D WIDTH R LENGTH ft DEPTH R DISTANCE TO NEAREST WELL _ It FOUNDATION ft PROPERTY LINE R ❑ MOUNDED WIDTH `ft LEN 3TH R DEPTH R g DISTANCE TO NEAREST WELL R FOUNDATION_ (t PROPERTY LINE R (` Cl SUMPS WIDTH R LENGTH R DEPTH R ' DISTANCE TO NEAREST WELL R FOUNDATION_ R PROPERTY LINE R ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH R DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE _ R ❑ SEEPAGE PITS WIDTH R LENGTH tt DEPTH ft > DISTANCE TO NEAREST WELL ___fl FOUNDATION R PROPERTY LINE I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK.NVILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE:LAWS AND RULES AND REGULATiONS OF SAN JOAQUIN COUNTY- ff1 MIN M 24 HOU ADVANCE NOTICE REQUIRED FOR DwjP IONS-P EASE CALL.(209)953-7647•��7 S1CNE rum _ TITLEIDATEL / INT I �n Q N }� E VI O ME T L r sl ni WD O I 0 DEPARTMENT USE ONLY Application Accepted By Date -2-1F-71 C _ Area_a.2I Employee INO •T Final Inxpectton By _ Date T;541' , V ❑ SPECIAL PERMIT-Approved by Character of Soil 01 pth of 3 Ft: PIVSump Sall Character: .� COX3NIENTS �— PESC Received hec Amount Date Permit/ Involceq Permit ID# Code INFO By ash Remitted Service Rre oast R