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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTII DEPARTMENT 304 E WEBER AVE.31"FL-STOCKTON CA 95202 -(209)468-3420 NON-REFUNDABLE.PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED Joe ADDRESS &0 caviziP LAThFR[1r^' `�533U 5 CROSS STREET _LJ _ �yy APN�/ LJ 3Q CJ(S PARCEL SIZE OWNER NAME 1 A L,1F-�$�p�yr��[�. PHONE OWNER ADDFIF&S P n }( (C� �.�� C.ITY/STATFJZIP 1 AT /ZyP. ['A L:!Y , CONTRACTOR L'� E n; Cety' a I-r/N<y PHONE CONTRACTOR ADDRESS ' CITY/STATE/41? LICENSE ❑C-42 ❑C-36 OTHER_ NLMBER EXPIRATION DATE WATF.RTABt.EDEPTII: 117 i-7' 11 GEOGRAPHICAL INFORMATION: Coordinates X 3 ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION#_ TYPE OF WORK: J NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT J DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCY rJ COMMERCIAL ❑ OTHER_ NLMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFGCAPACITY gal #OF COMPARTMENTS_ ❑ GREASE TRAP TYPUMFG CAPAcnY gat #OFCOMPARTMFNTS (JS ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LME R ❑ LIFT STATION SIZE TYPE OP PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCI:TO NEAREST WCLL ft FOUNDATION ft PROPERTYLINE ft ❑ FILTER RED WIDTH A LENGTH t1 DEPTH_ ft DISTANCETONEAREST WELL_ tl FOUNDATION ft PROPERTY LINE R ❑ MOUNDED WIDTH fi LF>:GTx ft DEPTH R DISTANCE TO NEAREST WELL_ fl FOUNDAI'[ON_ ft PROPERTY LINE C3SUMPS WIDTHft LENOTH _ ft DEPTH ft DISTANCE To NEAREST WEI.I. ft FOUNDATION _ _ft PROPERTY LINE fl ❑ DISPOSAL PONDS WIDTII ft LENGTH _ y ft DEPTH ft DISTANCE TO NEAREST WELL _It FOUNDATION Il PROPERTY LINE ft Q SEEPAGE PITS NUMBER WIDTH _ 11 DEPTII ft DISTANCF.TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft 1 HEREBY CE FV THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNT"Y NA\CES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. •iMIN 1 UR AIT`ANC.I,NOTICE REQUIRED FOR INSPFCTIONS-PLEASE CALL(2091453-76Y7 SIGNFID rC TITLE Dv✓NF-IL, DATE VI O 7 f f H DU 1TT DE J - I �PARTMENJ U�SE�(y�VLApplicationAccepted B i Date f / d Area Employee ID# /— — Final Inspection Ry Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth or 3 Ft; AVSump Soil Character. CONIMENTS PE. SC Received Meld(! Amount Date P-cniU levoltt# PermlflD# Code INFO R esh Remitted Service R uest# oZ' l `i us 1123-2- 'Z 42.02.001 ONSITE WASTEWATER PERMIT 1222;2003