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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMITL• CALL(29,91953-7697 FOR INSPEC7 ONS ExPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS (15-75 %n l-I—._ __CrrY/ZIP_ L r,[L/— _-_ �1 4k L' <br /> / +! <br /> JI-L/�� F� / /✓w-y _ OS(( 1'r� L.' <br /> CROSS STREET <br /> _S��'/t APN __ __-_ PARCEL SRE L- •C, -� <br /> OWNERNAME_ _ �r _ L _ C ,C% / > C <br /> ---L�Gl6G�._ �Jtl 1�/L� �-I /Ufa .— PhtONE!_ 1�1�r� a Z Q <br /> OIYNERADDRESS''??` �JM� �— _ -- CITYISTATE/ZIP �'��G'" 7I �7 _ <br /> CONTRACTOR_-DL�T'92 - C_y/� ��/W/N_5 r_/n/�-- _-_ PHOIJE_-LQ CI SLY Z%/.0 <br /> CONTRACTOR ADDRESS -7 352S-3_S_>•_/<DS 70 L /4f— — CITYISTATEIZIP /Z C i" CSI <br /> / <br /> LICENSE :! C-42 I.! C-36 OTHER—___ /1 NOMBEn .S EXPIRATION DATE_ - - //Sr <br /> WATER TABLE DEPTH: _It GEOGRAPHICAL INFORMATION: Coordinates X-- Y <br /> U PERC TEST rl BUILDING PERMIT#__ LAND USE APPLICATION <br /> TYPE OF WORK: NEW INSTALLATION \- EPAI DDITION -. ENGINEER DESIGNED/ALTERNATIVE <br /> J REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: 1; RESIDENCE COMMERCIAL I..: OTHER <br /> NUMBER OF LMHG UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES' -- `�_ <br /> ❑ SEPTIC TANK TYPE/MFG — 1 f t` CAPACITY gal II OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG—___ CAPACITY __ gal R OF COMPARTMENTS— <br /> DISTANC�T NEAREST: WELL It FOUNDATION f1 PROPERTY LINE it <br /> v] LIFT STATION SIZE /yP TYPE OF PUMP Xtv� ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> S LEACH LINES LEACHING CHAMBERS —__�`(�5} _- s OF LINES _ LENGTH OF LINES it <br /> DISTANCE TO NEAREST WELL _ 1t FOUNDATION It PROPERTY LINE K <br /> ❑ FILTER BED WIDTH . _--. _ —_It LENGTH—_ _-- It DEPTH_ _— it <br /> DISTANCE TO NEAnE ST WELL _ it FOUNDATION — it PPIOPERTYLINE R <br /> ❑ MOUNDED W10--H _——_- . __—It LENGTH_ _ ft r°F IH, <br /> DISTANCE TO NEAREST WELL __. it FODUDADON — _ It PTIOPERTY LINE It <br /> SUMPS WIDTH — `£NGTrf--.._— .. .- — IT '- <br /> DISTANCETONEAREST WELL C' _ it FOUNDATION 'LO II PROPERTY LINE <br /> ❑ DISPOSAL PONDS WInu --- _—__1; LENGTH _ it DEPTH_ It <br /> DISTANCE TO NEAREST 'YELL---_—__. it f-OUNDATION _11 PROPERTY LINE it <br /> IR SEEPAGE PIT' NU1.19ER -..` -- WIDTH L-- __. _�1 DEPTH —1 — ft <br /> DISTANCE TO NEAREST WELL�/(j(i _ 11 FOUNDATION N/OT/ `1Y PROPERTYLINE_ :�/ it <br /> I HEREBY CERTIFY THAT 1 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 /> 101NIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953--97�697 <br /> SIGNED-- �- ,'- � - --- TITLE Gfh J/I^c -!/Ct - - DATE.. 'T3.Z/y <br /> All e_1 <br /> ji <br /> �L <br /> L <br /> A. tLacloff <br /> E 4T <br /> H <br /> F FF <br /> - DEPARTMENT US•EONLY <br /> Application A ` <br /> ccepted . . /� - Date t L4 Area SZ\i—— Employee IDDj 5 �rJ <br /> Final Inspection By � - Dale { _- SPECIAL.PERMIT-Approved by <br /> Character of Soil to De th of 3 Ft:--1 _ _ Pit1Sump Soil Character: <br /> COtAMENTS . . ,., --.L I <br /> -- --,r;•j tib'.. <br /> !1Permit <br /> , . <br /> --PE SC R— e�celved _a. _ ----- <br /> Ct!echlJ[, Amount Data Permit/ Invoice q Permit IDO <br /> Code IHFO B Cash R-e�mit�ted+- Service Re Lest JL <br /> fE /, T 7 <br /> zCoL 2�; L.L I)t�/O/!, i9 �'7C�) 7tril L/Ldc _TiI,�i - c>1) t-/• <br /> 42al <br /> �.,,I.I��X Y-1//:�l L. i(_:rf� c} -5 4JF'%SifZGvi `I LnYli.l�)'iQttYAf/►✓!'f�p#�ItslFpFf•r SY,tyERNt'F/ <br /> Ti ��i:_ •7E CF/.%G:J ��/i-// � '�s<�i.J/i,J) •/`C�' ef4 /�L/�f�•f ►�' t� `j jrK. /tl/' <br /> �i't 6jpn� E- `/> �1�f�•%�f�/•F 1� t/72-'.Zl/>u) L/� �G?/�ltrjl.�[ /h(/11�-// ,Z�c.,>XIC��J /C.LI- /-�r' ljr <br />