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ONSITE WASTEWATE" REATMENT SYSTEM PERMIT r SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-31'FL82'C -STOCKTON CA 909)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED �Zr� YIP JOB ADDRESS - CIT /Z L...�V` m APN� f-� 0 ko ��.' PARCEL SIZE Z�I- , D CROSS STREET e PHONE y OWNER NAME, ..- / �OWNERADDRESS Fl ACL 4, TO%T-4 - CITYISTATEIZIP ,p_ y —� CONTRACTOR o O 6-L, PHONE O CONTRACTOR ADDRESS CITYISTATEIZIP LICENSE Cl C-42 ❑C-36 OTHER - NUMBER ERPIRATION DATE -WATER TABLE DEPFH:. R GEOGRAPHICAL.INFORMATION'.",'Coordinates PERC..TEST tl,,.. - -BUILDING PERMIT# LAND USE APPLICATION# _ S r- TYPE OF WORK LJ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE LI REPLACEMENT 13 DESTRUCTION .-INSTALLATION WILL SERVE: O;RESIDENCE; - © COMMERCIAL Ll OTHER NUKI$ER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPFJMFG CAPACITY t�•�z%�. gal #OF COMPARTMENTS Q. GREASE TRAP TYPFIMFGCAPACITY; gal #OF COMPARTMENTS ' PKG TX PLANT DISTANCE TO NEAREST: WELL - R FOUNDATION ft - PROPERTY LINE R - Q LIFT STATION SIZE TYPE OF PUMP - ❑� SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS OF LINES':E� LENGTH OF LINES ft DISTANCE TD NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATIONft- PROPERTY LINE R ❑ MOUNDED WIDTH ft LENGTH '. 'ft DEPTH ft - DISTANCE TO NEAREST WELL FOUNDATION" fl PROP$RTY LINE R ElSUMPS WIDTH ft- LENGTH = ^,Y*' -' R DEPTH R DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE R ❑ DISPOSAL PONDS WIDTH ftLENGTH ••�tl:•. DEPTH ft DISTANCE To NEAREST WELL R FOUNDATION R PROPERTYSANE ft ❑ SEEPAGE PITS_ NUMRSR WIDTH ft DEPTH ft . DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE' R - I HEREBY CERTIFY THAT 1 HAVEPREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDI NANCP.S,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY.. 'E MINIMUM-4 HOUR AD AN ENOTICEREQUIREDFORINSPECTIONS-PLEASECALL(209)953-7697' - - ` ` DATE - O SIGNED 0. o MA, 41 �FE c� 5 S L ih HO I . _--.__. DEPARTMENT U.E ONLY ....:..... _ .-.. - �7 pplication Acc ed B Date I�- t[-�' d Area- Employee ID# 3 Final Inspection y _ Date'a P� ❑ SPECIAL PERMIT-Approved by l Character of Soil to Depth of FI: _ PitlSump Suit Character: - COMMENTS i�� O.i =ZZZ �-k6t,L:(/ L7 •Sar �5G • !1Thr- , PE SC Received_ Check#! Amount Date Permit/ - 'Invoice# .Permit ID#.. Code INFO 8 as Remitted Service Request# _ zLA 42-02-001 �'� `Y'� '�� -' C�.?�Yr- : - --D1g9WI791rASTEWATER PERMIT ;A.