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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOACUIN Cou+aTY EtMRONYENTAL HEALTH DErARTW',' 1868 E Nut I to-4 Av[NuE-STOCKTON CA 95205-(209)466.3420 <br /> NDN-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe AOoau ss '-1w) 11at/n P".ct CITY/ZIP—ALew f2") <br /> A( <br /> CROSSs1KEET Ate,11 ,t7�-�+—" 'd APN 017-110-4Q PARCELSIEE �• b6(MCrtS p <br /> I y..n.R NAY! PNOHL <br /> ( <br /> DVVWR ALIORPSS CITYISTATFMP <br /> i CONTRACTOR Tt'( C PHONE <br /> CONTRACTOR ADoRFSS _ �•. S f�YuE Il r A> '1 ._ t �� "'O~ <br /> f [; CltYl$TATE/ZIP <br /> i <br /> tJLENSE ° C42 :C•36 OTYER NUYeCR E:PIRATIONDATE <br /> WATER TABLE DEPTH'��Q y�3G bg5 it GEOGRAPHICAL 1NFORMATION: Coordinate! X Y <br /> PERC TEST / BUILDING PERMIT k LAND USE APPLICATION I1 ----- <br /> REPLACEMENT <br /> TYPE OF WORK: NewINSTALLATION LI RLpAHt/ADd TIOFI I I ENGe+CCRFTeGNE <br /> DD IALTERNATtVE <br /> REPLACEMENT I' OUT4)F.SERVECF.SEPTIC SYSTEM II DESTRUCTION <br /> INSTALLATION WILL SERVE: [.} RESIDENCE IJ COMMERCIAL ! OTHER <br /> MJMRtR OF LIVING UMTS: NuMnER Or BEDRCKIMS: NUMYER OFEMPL__OYEES: <br /> ❑ SEPTIC TANK Tv!PCNFO (:APAC:ItY gal /0F COWAPTMrWTS,_._'____._._. <br /> ❑ GREASETRAP TYPUMFG _ CAPACITY gal /Of COMPARTMENTS <br /> DISTANCE TO NEAREST: %W..I it FcnR%TATION I1 PNiN'FHIT LNf fl <br /> ❑ LIFT STATION SIZE TYPE OF PUMP Cl PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS IOrLINES LENDTHOFL#os <br /> _ PAY <br /> • <br /> DISTANCE to NLAREST MIL R FOLNYVITIOH R PROPERTY LINE. _R,E <br /> ❑ FILTER BED Wcim fl LEWFH it DEPTH__- '� d <br /> DISTANCE TO NEAREST YR LL ft FOUNCA11ON it PROPERTY LITE <br /> ❑ MOUNDED WIDTH 11 LENGTH fl DFPTH - CC JJJ}F/UPJ <br /> DISTANCE TO NEAREST t•ELL It FOUNDATION 11 PROPERTY LINEFAa out(.C6uN Ty <br /> ❑ SUMPS WIDTH fl LENGTH fl DEPTH----. <br /> DIS tANCE TO NEAREST VT.L I. fl FOUNDATION fl PROPERTY LRE wj1vT <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH R DEPT.I__ fl i <br /> DISTANCE TO NEAREST WELL fl FOUNDATION _fl PROPERTY LINE fl <br /> ❑ SEEPAGE PITS Nu~ WIDtH It DEPTH fl <br /> DISTANCE To NEAREST VVELL it FOUNDATICN _ fl PROPERTY LINE _ it <br /> 1 HEREBY CERTIFY THAT I HA'✓E PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE MTN SAN JOAQUiN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> AIPVJMUIW 48 HOUR 4DVANCENOT7CE REQUIRED FOR INSPECTIOL(2 <br /> l r! 1j 953-7697 <br /> SIGNED �!I / TITLE�TQ fit- �llrn(I� GATE C <br /> Nw.AA•,,,d•.a..1,N p.Iy,�•..aa.. <br /> sw•.w.a.al <br /> Iso. Lh�•,•,1+,Wa —_ <br /> I <br /> It <br /> 7E IIs _ <br /> �6 <br /> 1 mnm WeA <br /> uIa w•r <br /> _ DEPARTMENT Y �, <br /> Application Accepted By_ _ Oale 7 4-1Atea + +A Employee ID/ <br /> Final Inspection By ._ Date � I , ❑ SPECIAL PERMIT-Approved by <br /> Character of Soli to Depth of 3 Ft. PRI'Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Ihe Amount Invoice 0 Permit IDS <br /> PerTTNU <br /> Coda INFO 8 ash Remitted Date S/rvics RegHest i <br /> �lZZZ- n- <br /> 4241 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4(14118 <br />