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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 Ii JOB ADDRESS (-�2a 1 Cf? Olz CITY/ZIP CROSS STREET Dlnur c APN Z9_ D 2-0"-0 Z PARCEL SIZE 7 S-q"/ ppo OWNER NAME y ~PHONE w OWNER ADDRESS ITYISTATEfl1P CONTRACTOR ///�/1yL Lr lYL- PHONE 3{�1'S�OZ//7 •. ' i CONTRACTOR ADDRESS CITYISTATEIZIP LICENSE ft-42 ❑C-36 OTHER .NUMBER EXPIRATION DATE 07'31/O i WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y C PERC TEST # BUILDING PERMIT# O fro/b''20 LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADOITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT '7 DESTRUCTION INSTALLATION WILL SERVE: El RESIDENCE �COMMERCIAL J OTHER NUMBER OF LIVING UNITS' LO NUMBER OF BEDROOMS: fJ NUMBER OF EMPLOYEES: (�- SEPTIC TANK TYPEIMFG �i/r�� - CAP ACITY_��flC!.._ gal #OF COMPARTMENTS __ 4 ❑ GREASE TRAP TYPE/MFG_._ CAPACITY / gal #OF COMPARTMENTS ,--- 11 DISTANCE TO NEAREST: WELL /3b� ft FOUNDATION G ft PROPERTY LINE ' 60 R I 1` ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) 1 I& LEACH LINES bk LEACHING CHAMBERS 7i� #OF LINES '7 LENGTH OF LINES i DISTANCE TO NEAREST WELL /ZLD� ft FOUNDATION---50' ft PROPERTY LINE ❑ FILTER BED WIDTH ft LENGTH_ ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH__ ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ftT DISTANCE TO NEAREST WELL ft FOJNDATION It PROPERTY UNE ft `N ❑ SEEPAGE PITS NUMBER WIDTH_ ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE I HEREBY CERTIFY THAT I 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(209)953-7697 SIGNED TITLE �+.�rif DATE 1h # E(I I IV P UNTY N AL LT D P ENT I ( , I 5 i I I I �A3EPARIMENTJ 0-1 Yk n_� ---- - - -- Application Accepted Bq Date 0 2[ Area_ Employee ID# Date S Final Inspection I SPECIAL PERMIT-Approved by Character of Soil "opth of FtPIUSuump Soil Character: COMMENTS A-) -J 3 30�C --Qu PE SC Received �^OUnt Date Permk/ # Pernik D# Code INFO B Cash Remitted Service Re uest# _ �2 S' 2SoV33 0r S_Oo.ut7 0 b 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 101V07 I