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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT GOD E MAIN STREET-STOCKTON CA 95202.(209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 9010 W 1 1y�..,1�yi IN tzt> ;LD. ` CRYmp 9-r KTI N /�Z O(P U N D/N APN f r_ I�JD'O�- '� -O� PARC EL SIZE ��I CROSS STREET {� f�(t- /y p _ \ / C OWNER NAME •`-(n- r. •• 1.'S (fh AEzL �A H/N1 ) PHONE �Z- Il OWNER ADDRESS SA Ap�,Ct� A ^_ y CRYISTATE(LP CONTRACTOR LIVE ��O111 O^lc_ �CU�vV(t�/� /\ L PHONE Axil- 03 S 20l j)-t T42� CONTRACTOR ADDRESS TO4 W OAK— S- CITYJSTArFIZP I—OO( • �x LICENSE ,C-42 .C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST I _ -� BUILDING PERMIT IE LAND USE APPLICATION# TYPE OF WORK- NEW(NBTALLATTON REPAwJAD moN ENGINEER DESIGNEDIALTERNATNE REPLACEMENT DESTRUCTION ( INSTALLATION WILL SERVE: ._ RESWCNCE COMMERCIAL - OTHM NUMBER OF LMNG UNITS: NUMBER OF BEDROOM,: NUtlBER OF EMPLDYEEs: ❑ SEPTIC TANK TYPF/MFG CAPACITY gel ROFCOMPARTUFNTS ❑ GREASETRAP TVPFIMFG -.._- CAPACITY _ gel AOFCONIPARTMENTS DISTANCE TO NEAREST: WELL ft FoUNIATvcN ft PROPERTY LINE_ ft ❑ UFT STATION SIZE __TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) O LEACH LIXES LEACHING CHAMBERS N OF LIES LENGTH OF LINES R DISTANCE TO NEAREST WELL It FOIR40ATON R PROPERTY LINE ft ❑ FILTERSED wwTH_—_--___ft LENGTH R DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LIME ft ❑ MOUNDED WBTH_ It LENGTH R DEPT ft DISTANCE TO NEAREST WELL R FOUNDATION 0 PROPERTY LINE R ❑ suMPs waI It LENGTH It DEPT ft DISTANCE To NEAREST WELL R FOUNDATION It PROPERTY LINE It ❑ DISPOSAL PONDS WIoTH _ ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LME ft .] SEEPAGE PITS NUWFR WNIDTII It DEPTH DISTANCE TO NEAREST WELLft FOUNDATION it PROPERTY LINE It --EREBV CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DOME IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, [�/j/fJ� STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY. , v_f 24 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(20!)11153-7411117SIGNED _� TITLE L anl�i v�-T A N'T DATE f 0-3.3 _ -- - - - ---_ PA y4f, FCF�4NT OCTam -to.4Q(j 2015 IAO CO DCA TMS DEPARTMENT USE ONLY 11 Application Accepted B __. Are1 V 1,1:'ke1 Final Inspection By c,� Data $PECIA PERMIT-Approved by Character of Soil to Olepth of t: P1 mp Soil Character: COMMENTS 124 1C' PE BICR.o.W.d Ch Amount Data MrrrlW Invoice 6 PeEmit IDA Coda two By smkbd Sarvia Removit A 112 Z 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT Ta41nr