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ONSITE 'WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HL 4TiI DEPARTMENT 1868 E.HAZELT3N X.ENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT }� CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �5 %/ /..�� /(� CITY/ZIP <br /> CROSS STREET CJ�.' i.�n�//./oA/ APN_C)8 `..= _I�L�. PARCEL SIZE <br /> 1 GKCJ�/J 'y <br /> OWNER NAME s1-14 Q7—� PHONE <br /> v <br /> v <br /> OWNER ADDRESS <br /> CONTRACTOR �/e– ,�!' -lKw l il-[f PHONE 9 J^ tz///' T <br /> CONTRACTOR ADDRESS ,"/S*22�__Iil _4 CITY/STATF/ZIP <br /> LICENSE Y,.C-42 .,,C-36 OTHER,___/'I ___. NUMBER 9 S '74) EXPIRATION DATE____.. <br /> WATER TABLE DEPTH: - 11 GEOGRAPHICAL INFORMATION: Coordinates X_ Y <br /> PERC TEST #_ � BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAWADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEW:NT _ _ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: 17 RESIDENCE COMMERCIAL OTHER.______ <br /> NUMBER OF LIVING UNITS: _ _ NUMBER OF BEDROOMS: _ NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG c L CAPACITY 200 gal #OF COMPARTMENTS <br /> GREASE TRAP TYPFJMFG f 4�J___ .7_ _ CAPACITY �fz_O U gal #OF COMPARTMENTS �--� <br /> DISTANCE TO NEAREST: WELL C/wl__ it FOUNDATION 7 ,7 It PROPERTY LINE /D 1Z. it <br /> L3 LIFT STATION SIZE _----__TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ------— ! <br /> LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES- yD ft <br /> DISTANCE TO NEAREST WELL It FOUNDATI J/jj P R Y INE it <br /> ❑ FILTER BED WIDTH ft LENGTH_ _ ) t�s7�rD)PTH� it <br /> DISTANCE TO NEAREST WELL It FOUNDATION 11l!,, PR R LIN _ ft <br /> ❑ MOUNDED WIDTH ft LENGTH may UE Ig pyni, ,•,., <br /> it <br /> DISTANCE TO NEAREST WELL It FOUNDATION`• 0�h?un coar�u OfL,""/ry�t))���-ft <br /> ❑ SUMPs WIDTH it LENGTH 'ly=, ��-�„ DL I �speLtea ft <br /> DISTANCE TO NEAREST WELL __ ft FOUNDATION ��t --jTF4&j&0j - j�� _It <br /> El DISPOSAL PONDS WIDTH _ft LENGTH_ __ ft DEPTH —It <br /> DISTANCE TO NEAREST WELL_ It FOUNDATION _ft PROPERTY L44E it <br /> SEEPAGE PITS NUMBER_-$__ W10TIl _ft DEPTH 7i� _It <br /> DISTANCE TO NEAREST WELL_C_neI4,4__ it FOUNDATION ID --Z it PROPERTY LINE _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 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> TITLE_ r;�e� C) DATEle 1Z� I <br /> NJ Al <br /> J. N <br /> FPILL <br /> ARTMENT USE ONLY <br /> Application Accepted By /Vf�'/�Y(/�_ _ Date_ Z�� �� Area VD4_15r1___ Employee ID# f–S4Z f15 <br /> Final Inspection By_ _ Date_- 0 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: _ Pit/Sump Soil Character: <br /> COMMENTS /124-% Id t MC6'Zt- 6114aT-C 7l�4' Z 'L-71'21c '--hl e,2;7 '5;ZZ M1 - <br /> PE SC Received(– Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Re uest Y <br /> 2� 1 ¢sz>— <br /> 42-01 ONSfTE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24%12 <br />