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1-11 <br /> ONSITE WASTEW; 'R TREATMENT SYSTEM PERMIT ,3 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTML 600 E MAIN STREET-STOCKTON C/ -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209)953-7697 FOR INSPECTIONS ^�EXPIRES 1 a YEAR PROM DATE ISSUED <br /> 00-7 �/ pBF' �j D CITY/ZIP <br /> JOB ADDRESS <br /> CROSS STREET fyl � 7�/ APN U!3-z-f PARCEL SIZE (_7-3 <br /> OWNER NAME ctSS IE W ( `'e�JS PHONE y <br /> OWNER ADDRESS F '�/y CITY/STATE/ZIP .i� C <br /> CONTRACTOR � f��t ��✓r n L 1 � PHONE ?� `x]� ZS 7 7Q <br /> CONTRACTtO-R�ADDRESS [�+t CaI.I.'I~-1�t7 ^ CITY/STATE/ZIPDL -t <br /> LICENSE OG C-42 ❑ C-36 OTHER NUMBER /� EXPIRATION DATE 02-fey,(0 1 <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# 07&0a Z LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION 13REPAIR/ADDITION O ENGINEER DESIGNED/ALTERNATIVE <br /> O REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE E3 COMMERCIAL , 11 E3 OTHER <br /> NUMBER OF LIVING UNITS: `�4 NUMBER OF BEDROOMS: "1' NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG f I-660% 'F CAPACITY iO Bal #OF COMPARTMENTS Z <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) t <br /> t,.� <br /> O LEACH LINES Yf LEACHING CHAMBERS #OF LINES L► LENGTH OF LINES 670 ft <br /> e <br /> DISTANCE TO NEAREST WELL S-0I A- ft FOUNDATION I ft PROPERTY LINE <br /> O FH TERBED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft C <br /> C1 MOUNDED WIDTH ft LENGTH ft DEPTH ft C <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME ft <br /> ft t <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> O DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> " <br /> SEEPAGE PITS NUMBER L WIDTH 42-11 R DEPTH -2"51 ft <br /> DISTANCE TO NEAREST WELL V C,0 1 4-ft FOUNDATION i St R PROPERTY LINE I T� ft <br /> I HEREBY CERTIFY THAT i HAVE <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SAN JOAQUIN COUNTY <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209)953-7697 / <br /> SIGNED TITLE DATE to IC) 1 O—I <br /> c <br /> R <br /> .Y R <br /> c" <br /> 5 a <br /> 9 <br /> DEPARTMENT YSE 9NLY -573&(" tr <br /> Application Accepted <br /> Date t'313 U 7 Area Employee ID# 41. <br /> Final Inspection By Date 0 SPECIALL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> CO S (UcD teTn>c /L <br /> Q—D iit7�r/ 1 <br /> PE SC Received ec Amount Date Permit/ Invoice# Permit Dkl <br /> Code INFO B Remitted Service Re nest# <br /> 42-13110 (-f <br /> ONSITE WASTEWATER PERMT <br /> av_nt <br />