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ONSITE WASTEWATER T1ETMENT SYSTEM PERMIT
<br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420
<br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED
<br /> Joe ADDRESSO
<br /> CROSS STREET KLCN/VF'SGI< .� _ ......_.......__ APN_!!..L.7 !�Q-�.._._-......_____.___........PARCEL
<br /> OWNERNAME.. . OV&4 ..__,.._...._._...,._.._... ._.,_.....,._.,,,...,,,..-_..._._._..__.__............._..._-...___._......._.__.PHONE_,,,,_, /�
<br /> OWNERADORESSS 3^3wy� )455,* *V Rib ____--_--,._.CITY/STATE//ZIP 6rt_4 i/lOD C-Jp+�j'?S_ZZ0
<br /> CONTRACTOR S/.L...Se�.+7[-+isL=.='7.�i 'Q7IY........_.._.__.—.._.--.__._...__._._,_............
<br /> CONTRACTOR ADDRESS ..............__...................._._._._—_._.._-_........_......_...,..._..._..__........_......_..CITY/ST`ATE/ZIP.......... ._._
<br /> LICENSE i -42 f" C-36 OTHER NUMBER_-Q?aY-5-le—
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<br /> _!l� L.__..�.i w EXPIRATION DATE,,,,,,,_,
<br /> WATER TABLE DEPTH: ....._-_„_.___„_.____,it GEOGRAPHICAL INFORMATION: Coordinates X_...... Y -
<br /> PERC TEST #........_..._ BUILDING PERMIT# �. (� LAND USE APPLICATION
<br /> TYPE OF WORK: ... NEW INSTALLATION .. EPAm/ADoITION - ENGINEER DESIGNED/ALTERNATIVE
<br /> REPLACEMENT .__._ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION
<br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER
<br /> NUMBER OF LIVING UNITS:,,, NUMBER 0�BEDROOMS:_.....,,.J _.. NUMBER OF EMPLOYEES:,__-_,,,,_
<br /> SEPTIC TANK TYPEIMFG ,t�yST (s .yy,.... CAPACITY t 2 moogal #OF COMPARTMENTS 2
<br /> ❑ GREASE TRAP TYPEIMFG _ , _ - ._ CAPACITY _- ,_.._ _ !gal #OF COMPARTMENTS,_„__...._____..___.._
<br /> DISTANCE TO NEAREST: WELL....................... ft FOUNDATION„__._._.................._..._. it PROPERTY LINE
<br /> ❑ LIFT STATION SIZE .........._......_........_.......TYPE OF PUMP,__-_.,_..........__... ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM)
<br /> Lf LEACH LINES ✓LE ACHINGCHAM8ER8 IA'C:I-w-fow _____ it OF LINES f LENGTH OF LINES_ yb it
<br /> DISTANCE To NEAREST WELL-_�„D_� ft FOUNDATION_..1G!,t...._-.._._..._...1t PROPERTY LINE___.._(. .....ft
<br /> !-�,_............._._._..__.
<br /> ❑ FILTER BED WIDTH ft LENGTH _._—------ __..__ ft DEPTH ... _ _.. _. ._.. _._.� it
<br /> DISTANCE TO NEAREST WELL W _- it FOUNDATION it PROPERTY LINE ft
<br /> ❑ MOUNDED WIDTH it LENGTH.._._..r_.....___...__.__.. _. _ it DEPTH__ it
<br /> DISTANCE TD NEAREST WELL it FOUNDATION-„-__„__,____„_-it PROPERTY LINE it
<br /> ❑ SUMPS WIDTH _______it LENGTH .._ _.,......_....._ __.-__ft DEPTH........__..._--' --it
<br /> DISTANCE TO NEAREST WELL,__-..W-_..__......-it FOUNDATION,_.,�_.._.__._..........._.ft PROPERTYLINE It
<br /> ❑ DISPOSAL PONDS WIDTH.�_____..._... it LENGTH_.._.__._..........._....................._......... ___-_ft DEPTH it
<br /> �� DISTANCEToNEAREST WELL,.____. it FOUNDATION_ W_ft PROPERTYLINE,____ _ft
<br /> ,0 SEEPAGE PITS NUMBER.............._ it DEPTH_........._'1-S_..................... _...... ._......._ft
<br /> DISTANCE TO NEAREST WELL_-_J_!S�Q.______it FOUNDATION__........ it PROPERTY LINE,_,_,_._,gy_ .-it
<br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES,
<br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY.
<br /> MINIMUM 247HOUR ADVANCE ICE REQUIRED FOR INSPECT! NS-PLEASE CALL 209 953--7697
<br /> SIGNED _ __.__...._ _... TITLE, !VE� _.__._--_-- DATE
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<br /> Application Acce Date.,_.,_. Area.-„ �"L..�.. Employee IDn_Cl14�' 7 Q
<br /> Final Inspectio Data_ SPECIAL PERMIT•Approved by
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<br /> Character of Soil to pt of 3 Ft:_ ._,_ _—_.._........._..._._ Pivsump Soil Character:
<br /> COMMENTSLO _C'S.�
<br /> PE SC Received Check#1 Amount �Do
<br /> atte —� Permit/
<br /> Invoice# Permit ID#
<br /> Code INFO B Cash Remitted Service Request#
<br /> 7 IL s 535(D
<br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT
<br /> 4124/12
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