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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT Y ALL 209 953-76R INSPECTIONS EXPIRES t YEAR FROM DATE ISSUED J00 ADDRESS -J CITY/7jP L �1 _Z A ` CROSS STREET - _ _ _. APN_� Znn0 PARCEL SIZE r OWNER NAME PHONE jD'rJ 0-75 r n OWNER ADDRESS -j'"4 ,7/ CRY/STATE/ZIP _/�✓s�/ �t. _ /�`/�� -_ CONTRACTOR _- PHONE CONTRACTOR ADDRESS _ CITY/STATE/ZIP LICENSE ,C42 TYC M OTHER___- _ -_ NUMBER EXPIRATION DATE WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST •__ _ _.__ l BUILDING PERMIT# . LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDRION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT ' ` OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: 11 RESIDENCE COMMERCIAL OTHER_____ U R OF LIVING UNITS: __ NUMBER Of BEDROOMS: a 2,4z _ NUMBER OF EMPLOYEES: VANK TYPE/MFG +Sl+{ CAPACITY - _ gal #OF COMPARTMENTS �_ GREASETRAP TYPE/MFG _ _ CAPACITY _ — gal #OF COMPARTMENTS DISTANCE 10 NEAREST: WELL __. it FOLINUATION_-- IT PROPERTY LINE _ it ❑ LIFT STATION SIZE TYPE OF PUMP _- Cl PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTFIM) ❑ LEACH LINES LEACHING CHAMBERS_._ #of LINES_ LENGTH OF LINES R DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY UNE_ _ It ❑ FILTER BED WIDTH ft LENGTH ft DEPTH — ft DISTANCE TO NEAREST WELL II FOUNDATION ft PROPERTY LINE_ __ _ ____ ft ❑ MOUNDED WIDTH _ It LENGTH_ _ It DEPTH_ It DISTANCE TO NEAREST WELL __ II FOUNDATION K PROPERTY LINE It ❑ SUMPS WIDTH — It LENGTH_ It DEPTH N DISTANCE TO NEAREST WELL 11 fOUNDATION h PROPERTY LINE._. ft ❑ DISPOSAL PONDS WIDTH __ --ft fl LENGTH_ _ _ _ _ it DEPTH _ _ It DISTANCE TO NEAREST WELL___ it FOUNDATION_._ _It PROPERTY LINE_ it ❑ SEEPAGE PITS NuusER _ _-__ WIDTH--- N DEPTH it DISTANCE TO NEAREST WELL If FOUNDATION_ _ K PROPERTY LINE 1 14EREBY CERTIFY THAT 1 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. MI U 4 UR ADV NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED _ TITLy ��y�,.1- DATE -1 "JEA A O L7 — DEPART E T �y� Application Accepts _ Date_ Area Employee ID# Final Inspection Date_ ��f SPECIAL PrEFi7MIT•Approved by Character of Soil to D90th of 3 Ft: . ._...____. _ PIVSump Soil Character: - ___ — COMMENTSa — u -� ' - I Tom,� 1 _._ 3�_.k�aiw PE SC Received Cfie AmountermiV Code INFO B Remitted Data Service Re uest# Invoice N Permit ID# U SV L4 I _�'��-1U �J - 3/I-3/ -a! �`��ti.J�• Gu+tcir+��F-�. - ,�/g�/y fl �->,,,. ! 42-011 I ` _ pNSIT WASTEWpTEF TRTMNT SYSTEM PERMIT wne1.o�113/1•Z^-ZtCx.l -3�7///yt�4� ��f'i.FIIaI xo N"t 1��CiC�TC.w-16��CL!'►ltT. 7.A7�_1 - �. /�,i..- /i