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/,j= //'2'Y <br /> uwl� /Z:qz ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> N6N-REF3NDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS..- �✓• --.. _ CITY/ZIP IkAiMAO_...._... _[+t/ <br /> o! <br /> CROSS STREET ..._ 9 Frr.� APN ... <br /> _ .."� ��.. .............—___......PARCEL SIZE_�0-S 7_ y <br /> _ Z��Jj JJ ......_ C <br /> OWNERNAME {� ._.____..._—.....__. ____ ,PHONE0 <br /> OWNER ADDRESS Q.I�L_. ._�_..J_L__-- ........_CITY/STATE/ZIP ��`�.'NJP� <br /> CONTRACTOR L 14 46.107M7L PHONE "'k`• S <br /> 2-5r-11 <br /> CONTRACTOR ADDRESS CJ" l'J-_,�/•:. __..._CITY/STATE/ZIP,_ 1--- 4 <br /> LICENSE C-42 ,� C-36 OTHER NUMBER Az <br /> WATER <br /> EXPIRATION DATE 1. <br /> WATER TABLE DEPTH:j„_7_--____ft GEOGRAPHICAL INFORMATION: Coordinates X--_,-- __..... Y___.._...... <br /> ._— <br /> ERC TEST #_. _.-_-„-__ BUILDING PERMIT#_._- IJ.. t ..__ LAND USE APPLICATION <br /> TYPE OF WORK: .y NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT �O/UT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION—_ <br /> INSTALLATION WILL SERVE: l RESIDENCE /~COMMERCIAL OTHER.,..,_ R� ._r'fi JO WN�___ <br /> NUMBER OF LIVING UNITS:.................. .__.__.........._ryry... rN�UMBER OF BEDROOMS:.__.......... NUMBER OF EMPLOYEES'. 1y <br /> SEPTIC TANK TYPE/MFG `„ t..�Dl Sii CAPACITY V� gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG ... CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL 2010 ft FOUNDATION_- _ ft PROPERTY LINE „9:QS�v_ft <br /> ❑ LIFT STATION SIZE _ _TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> A LEACH LINES <br /> LEACHING #OFLiNES� LENGTH OF U.— W It <br /> DISTANCE TO NEAREST WELL____,_---,ft FOUNDATION_,-,___._......_........._—it PROPERTY LINE----.it <br /> ❑ FILTER BED WIDTH .__._.___-___-_____it LENGTH ft DEPTH_ fl <br /> DISTANCE TO NEAREST WELL it FOUNDATION It PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH___...._._......................_.._...__ft LENGTH-......_.------- ft DEPTH _It <br /> DISTANCE TO NEAREST WELL j_5 It FOUNDATION it PROPERTVY—— ft <br /> 1 <br /> I SUMPS WIDTH it LENGTH �ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE...__. .-,..,it <br /> ❑ DISPOSAL PONDS WIDTH. _it LENGTHft DEPTH It <br /> DISTANCETO N W ELL__,_ , ft FOUNDATION_. ,_,it PROPERTY LINE it <br /> SEEPAGE PITS NUMBER„_:__. WIDTH_______., _._ —ft DEPTH__ it <br /> DISTANCE TO NEAREST WELL_____ ft FOUNDATION_ it PROPERNE it <br /> I HEREBY CERTIFY THAT I 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 /> MINIMUM 24 HOUR DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED...,..,_ 4 TITLE AiY�G. _ _ DATE <br /> 14 I !. <br /> T <br /> 0V 67Z 4. :N — <br /> �ila 14L <br /> I- - <br /> U; L E•O <br /> " • DEPART hyt NL y�� <br /> 4Application Acce _ _ �„_. Date—,�.�- ? Area � _ Employee ID# E S C C f� <br /> 17/7 <br /> Final Inspection __ _ - Date ..y�rT-..—.-._ Ci SPECIAL PERMIT'Approved by <br /> Character of Soil to epth of 3 Ft:_ _ PIi/Sump Soil Character: <br /> COMMENTS L o L of' /1eCo,2LJ rk-_gl—IC <br /> PE SC Received Choc Amount PermW Invoice# Permit ID# <br /> Code INFO 8 �Cash Remitted Date Service Request# <br /> 125;27 s-a cv 1 F0 0 3 1 r 2: <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />