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11 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205.(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESScITYrzIP _—Z LZi r <br /> - — -- <br /> CROSS STREET 4/ APN_♦'0-5=(� ZZ •__ _—_—PARCEL SIZE <br /> OWNERNAME__ F <br /> —___ __...___--. PHONE <br /> OWNER ADDRESS _ _ CITY/STATE/ZIP _ <br /> CONTRACTOR ,� � j r�.A(�f/ _ _—PHONE ��-'10W141 <br /> CONTRACTOR ADDRESS /n----"�_� ._['._�///.{{{ CITY/STATE21P <br /> LICENSE -42 ,,C-36 OTHER LA <br /> NUMBER 9<0;� EXPIRATION DATE__ <br /> WATER TABLE DEPTH:_ ft GEOGRAPHICAL INFORMATION: Coordinates XY_— <br /> r PERC TEST N V.63.2 h LAND USE APPLICATION# _ <br /> TYPE OF WORK: 16, NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT __ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION_ <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: �,i NUMBER OF EMPLOYEES' <br /> SEPTIC TANK TYPEIMFG C_ - _ _ CAPACITY �15- _ gat #OFCOMPARTMENTS_-21— <br /> ❑ GREASE TRAP TYPE/MFG _ CAPACITY_-----c�!��------_, gal #OF COMPARTMENTS <br /> DISTANCE To NEAREST: WELL Zn6 It FOUNDATION , R PROPERTY LINE _(t <br /> .❑J LIFT STATION SIZE TYPE OF PUMP__—.-_(3 PKG TX PLANT C1 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> /gyp LEACH LINES LEACHING CHAMBERS_ #OFLINES LENGTHOFLINES _�—it <br /> DISTANCE TO NEAREST WELL. _r <br /> It FOIINUATION_.2�Z�_ It PROPERTY LINE � ff <br /> ❑ FILTER BED WIDTH it LENGTH _.—__— h DEPTH _it <br /> DISTANCE TO NEAREST WELL-____ It FOUNDATION _ it PROPERTYUNE It <br /> ❑ MOUNDED WIDTH __—__ ._ ___it LENGTH—_ ft DEPTH it <br /> DISTANCE TO NEAREST WELL_.______, it FOUNDATION it PROPERTY LINE ft <br /> ❑ SUMPS WIDTH _._,__ ----_it LENGTH——,—_____ __ R DEPTH_— it <br /> DISTANCE TO NEAREST WELL___. R FOUNDATION f( PROPERTYLINE it <br /> ❑ DISPOSAL PONDS WIDTH_ it LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL _fit FOUNDATION it PROPERTYLINE R <br /> SEEPAGE PITS NUMBER WIDTH---3. R DEPTH z4 <br /> , (; <br /> DISTANCE TO NEAREST WELL CDU�-�' It FOUNDATION��;L R PROPERTYLIN—E.S (f <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIM4 24 HOU VA E NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED __ _ TITLE _ DATE <br /> n <br /> JA <br /> I 14-44V <br /> hr rr <br /> f <br /> I <br /> _.. - _. <br /> -T' _ /1_1. .. . — <br /> bl I LL -iVI I S I <br /> -1 _ _ r L H E'A T TEr <br /> DEPARTMENT USE ONLY `'' �} <br /> Application Accepte d` // Date_ 1 11 Y__. Area _QQ7- �i�! Employee ID#_L_S tJo ILC: <br /> Final Inspection Date I . U SPECIAL ERMIT-Approved by <br /> Character of Soil to D th of 3 Ft: _ _ Pit'Sump Soil Character: __ ___7 _ <br /> COMMENTS <br /> PE SC Received heck#/ Amounr Oai ~^ Permit/ —Invoice# Permit ID# <br /> Code INFO B Remitted Service Re Uest# <br /> Pit 11_1 10 <br /> t (o � 73 9 �� ►t4' '— �5 <br /> 42-W ONSITE WASTEWATEII RTMNT SYSTEM PERMIT <br /> 4,74112 <br />