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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 NON-REFUNDABLE PERMIT r CALL(209)953-7697 FOR INSPECTIONS T EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS I �'I•(� FZ/�[ FV CITY/ZIP Ly V -1 0 y a1 G ,fir H CROSS STREET ` �Z ,��„ APN vS Z�y_ 1 PARCEL SIZE T•6 o "" o OWNER NAME L_ `y P_jN {-�)IJX pC.rA A PHONE � `^� I'S�9(,9 y OWNER ADDRESS .I 44� ` 'FO1` 9--,;-,'^n CIN/STATE/ZIP? Lq��O� `� —( Z" l a CONTRACTOR L'1y t D� &-E t:XM p- mF'�Te PHONE 7� 7�03�,,7/� p �,�/� CONTRACTOR ADDRESS 4o-1 W' V�- + , ' CITY/STATE/ZIP L-0 ( C A -/��'- , v LICENSE C42 .0-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y X PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: -i NEW INSTALLATION ., REPAIR/ADDITION " ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT I! DESTRUCTION INSTALLATION WILL SERVE: _ RESIDENCE I COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE it ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH it LENGTH it DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R ❑ SUMPS WIDTH it LENGTH ft DEPTH It DISTANCE To NEAREST WELL ft FOUNDATION it PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. IMUM 24 HO DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 q SIGNED /` TITLE GO-NSJLTIY+�'r DATE f) 8 I I �+� t c M,FINr _ I N00 it7 H+hP4VF ails 1QCVO7UiVfTY DEPARTMENT U E 0 Application Accepted By Date RC1 Area Employee ID#� Final Inspection By Date W J SPE IAL PERMIT-Approved by Character of Soil t5,,Depth of 3 Ft: Pit/ ump Soil haracter• COMMENTS PE SC Received Check#/ Amount Date PermiU Invoice# Permit ID# Code INFO B Cash Remitted Service Reguest# y � l58 Z lu•�Z•. ��a, . 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT