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PERY, Ks 1 J JOAQUIN COi3LlQ�fID ASTE IRONM I.HEALTH DIVISION I 304 E.WESER AVE 3R"FLOOR,STOCKTON,CA 95202(209)46A-3420 NON-REFUNDABLE PERMIT-EXPIRES 1 YEAR FROM DATE ISSUED F� JOBADDRESS lL�/� .LAl�le of APN r �'( /J/'/ PARCEL SIZE: c k ' CITYIZIP - BUILDING PERMIT II OWNER NAME,,, f (�y}7J�y(1 ADDRESS I r ' CITYIZIP PHONE NUMBER -a PT_ r - - CONTRACTOR �jJ/iG j ST`G_ A➢DRESSIS( L_OIL-- CITYIZIP ��.- PHONE NUMBER GEOGRAPHICAL INFORMATION: COORDINATES: H Y TOWNSHIP RANGE SECTION TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS:_ ❑ NEW INSTALLATION RESIDENCE i NUMBER OF BEDROOMS: 1 REPAIR/ADDITION LI COMMERCIAL NUMBER OF EMPLOYEES ❑ DESTRUCTION ❑ OTHER +� ❑ ENGINEERED/ALTERNATIVE I CHARACTER OF SOIL TO DEPTH O.F 3'i PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: . fl PERC TEST(S) HOW MANY APPLICATION# t ❑ 'SEPTIC TANK TYPEIMFG_ j�[�y c, CAPACITY #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS ❑ PKGTX PLANT DISTANCE TO NEAREST:. WELL FOUNDATION PROPERTY LINE i ❑ LIFTSTATION SIZE TYPE OF'PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) I LEACH LINE #OEINLF TH OF LINES:,,-_' ' DISTANCE i0 NEAREST: WELL ) FOUNDATION_ r PROPERTY LINE.-,kgjg�" TRATOR CHAMBERS: ❑ FILTER BED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE I ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL, FOUNDATION PROPERTY LINE X . ❑ SUMPS WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: 'WELL FOUNDATIONT PROPERTY LINE f� ❑ SEEPAGE PITS # DIAMETER DEPTH .DISTANCE TO NEAREST: WELL, FOUNDATION PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONEINACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS ! - _ AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. !411NIMUM4 FLOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 \� SIGNED: TITLE:_ DATE: ' , ..i.., .- ..4 .. .. , ........„ l .,., .q..... .,.. ... /f I F : 1 f V - � k NEU ..... .........E. _ : ! 540. j r IF 4 •r'• _ V f f ... T .... 1 .. ..,.,..I. ..,.. .....,..- f- --,....,.., b......,l..,.. ,... ..r A... I , I I I 1.. .......,.. ; _?_ - .1 I , _. L.... : . I ! I ,-, I , __ I - I � ~ I ! I , p .. :_ - 1 ...... _ i I f DEPARTMENT U. V C APPLICATION ACCEPTED BY: - DATE: Q EA�EMPLOYEE[D# STRICT LOCATION�� INSPECT BY: -DAT �ERMITFINJ< YES.DATE��Gti3” SPECTOR: COMMENTS: _ - _ - P PE CODE SC INFO AMOUNT CHECK# ASH RECEIVED DATE PERMIT/SERVICE REQUEST# INVOICEH SEPTIC IDN REMITTED 3Y - qD a `� �2 ✓pa� 39�Z REVISED 11-15-01