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i <br /> -ONS1 TE WASTE-WATERTREATM ENT SYSTEM PERMIT <br /> SAN JOAllt11PI COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE_-STOCKTON CA 95205-(209)463-3420 <br /> BION-REFUNDABLE PERMIT (:TILL.(209)R" $-7697 FOR INSPECTIONS _ EXPIRES " YEAR FROM DATE ISSUED <br /> JOBl,DDRESS 9 1116 / QI�_ p CITY/ZIP "W'4-16 jy -'�� <br /> CROSS S IP.EET �ft iL -- APl�I �0 DQd J —PARCEL SIZE -I <br /> OWNER NAME , -� � �—� _. PHONE <br /> GINNER ADDRESS Lr CITY/STATE/ZIP <br /> CONTRACTORCtuip,cLL., 3' a, / __ PFIONE20 —_—_-- <br /> CONTRACTOR ADDRESS CITY/STATE/.GIP <br /> LICENSE ❑nC-42 1_11-IC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 0 PERC TEST # BUILDING ri-"ERMI T 9 40 R' /?_0-3 Jj�e LIAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION i J RF-PAIR/ADDITION ENGINEER DESIGNED(ALTERNATIVE <br /> REPLACEMENT I' OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE R COMMERCIAL ��C� OTHEF, <br /> NUMBER OF LIVING UNITS:_— — NUMBER OF BEDROOMS: Aa— (1f/ -R F MPLOYEES: <br /> SEPTIC TANK TYPE/MFG — _ CAPACITY / lJal /1=OF COMPARTMENTS 2. <br /> GREASE TRAP TYPE/MFG _ CAPACITY --_ gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> E3 LEFT STATION SIZE ^_-TYPE OF PLUMP, M PKG TX PLANT 1-7 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS It OF LINES LENGTH OF LINES ��� ft <br /> DISTANCE TO NEAREST WELL /d_0 ft FOUNDATION__�&_ft PROPERTY LINE (S ft <br /> FILTER BED InrIDTI-I ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL_ ft FOUNDATION ft PROPERTY LINE ft <br /> MOUNDED WIDTH _ft LENGTH ft DEPTH_ it <br /> DISTANCE TO NEAREST WELL — ft FOUNDATION _ft PROPERTY LINE ft <br /> SUMPS WIDTH Z_—_ ft LENGTH _ 14' ft DEPTH_j YMENT ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE �'��Dft <br /> CAT DISPOSAL PONDS WIDTH ft LENGTH — ft DEPTH _ IUL 2 4 2019 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION _ PROPERTY LINE_ <br /> SEEPAGE PITS NUMBER VI/(DTH ft EPTH__ - _ `SAN JOAQUIN COUNTY <br /> DISTANCE TO NEAREST WELL. ft TFOLINDATION ftFFMR�N1Jf�NTAC <br /> — PROPERTY LINE 1iEALTH I3EPARTMEN+ <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE VVI SAN JOAQUIN COUNT(ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 HOUR ADVANCE NOTICE f;EQ�UiRF D FOR INSPECTIONS - PLEASE CALL (209) 953-7697 � <br /> SIGNED [A&,&, bra./ TITLE 4 DATE� Q <br /> A o <br /> it <br /> {) n P RTMEbjT U S E OIV!_ Y <br /> Application Accepted 6TV1r hate z0A!3- Area - Employee ID#-- — <br /> Fina!inspection By Date IF T ❑ SPECIAL PERMIT-Approved by <br /> Chari cter•of Soil to Dept-h of 3 Ft.: _ _ Pit/SUInP Soil Character: <br /> �An.Q 'FQ - b S 7.( _rinn isf ryme�e f- Y\(JCWNIJ�a ��� �1,0 - --- <br /> GC csctil CZ 11G�. <br /> - PF - - ReceiveCi -- —Ecfl/ Amount --— Permltl <br /> t C3 /� Date Invoice# Permit ID# <br /> IN <br /> V I/Ba LTi Remitted _ S�rvice I oast# - 7 2S <br /> p�,^� Fc <br /> i -- - r <br /> see <br /> ✓sQr <br /> PGh � WASTEWATER VTf <br /> -7rv- 0 'may s�mP �� r�eGl. 4lill <br />