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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468.3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES_1 YEAR FROM DATE ISSUED JOB ADDRESS .�—Zaw e12 O CITYIZIP�n CROSS STREET D/7U/{ APIN 0Z-! — D �Q Z PARCEL SIZE O OWNERNAME PHONE OWNER ADDRESS ITYISTATFJZIP CONTRACTOR JS,5,1,4✓- PHONE CONTRACTOR ADDRESS ;I-1W fiO.i9LU2cf �/l/VG� CITYISTATE/ZIP��L.c• .' LICENSE QIlC-42 OC-38 OTHER :NUMBER 4/.S EXPIRATION DATE 07 3/-/U WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y 1 L PERC TEST # BUILDING PERMIT# D fr0I S-7D LAND USE APPLICATION# I 11 TYPE OF WORK: P NEW INSTALLATION I' REPAIR/AnmoN ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: 0 RESIDENCE `19 COMMERCIAL J OTHER NUMBER OF LIVING UNITS: G NUMBER OF BEDROOMS: lS NUMBER OF EMPLOYEES: ' I8 SEPTIC TANK TvPE1MFG �ii�t� CAPACITY- gal #OF COMPARTMENTS _ ❑ GREASE TRAP TYPE/MFG _ CAPACITY gal #OF COMPARTMENTS _ DISTANCE TO NEAREST[ WELL /30' ft FOUNDATION G I ft PROPERTY LINE �jI'D ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) IS, LEACH LINES LEACHING CHAMBERS ffp J?jj�' #OF LINES �7 LENGTH OF LINES_k'/ DISTANCE TO NEAREST WELL /'%b' ft FOUNDATION 56 It PROPERTY LINE ft li I O FILTER BED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH_ ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH_ ftm - DISTANCE TO NEAREST WELL ft FOJNDATION ft PROPERTY LINE ft 1 ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I I HEREBY 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. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(2D9)953-7697 SIGNED TITLE /.�..es-�ic DATE - I F :P ae I IpPN 08 - - - — UNTY N AL LTH 11 P ENT I % I I i S I I ' I � I { I ._ - .•---. ,-DEPARZMEN7 U E ON Y-�_/ - - - - --- -_ Application Accepted B� a-.�� Date U X Area Employee ID# j 3�OG`� q9 Final Inspection Date 11 SPECIAL PERMIT-Approved by Character of Soil o-bepth of Ft: �Y. Plt/Sump Soil Character: COMMENTS A-) 3 3,) �c c! �L�Lr I✓�. N��/ . /'�2<�l-f c w.�u, ti�T�3 4G(rS_._ _ PE SC Received Amount PermiU Date # Permit D# Code INFO B 0 Cash Remitted Service Request 2f2 2so 0-- Soo.A�" l Q b t 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 101V07