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t t s ONSA ITE WASTEWATER TIREATMENT SYS-7E PERMI u SAN JOAQUIN COUNTY ENVIRONMENTAL-HEALTH DEPARTMENT 1868 E.HAZ_EI_TON AVENUE-STOCKTON CA 95205-(209)468-3420 NoN-REFUNDABLE PERMIT CALL(209)953-7097 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED Jon ADDRESS -1 z 7.ra P)e CIT Y/ZIP CROSS STREET �►t. _ APPr PARCEL SIZE OWNER NAME /I"� �!/1C[.�jIMCKa PHONE OWNER ADDRESS CJb2� 4 .M Z` _ _ CITY/STATE/ZIPA 04-A e A PA_ CONTRACTOR l�� L ��i�e _ PHONE CONTRACTOR ADDRESS w /e- Gk. CITY/STATE/ZIP � w LICENSE L)PIC-42 ❑FIC-36 OTHER NUMPFF DATE /p�SO�L✓ !MATER.TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PF_R 3 TEST # ( BUILDING PERMIT# LAND USE APPLICATION# TYPE OF UUORK: NEW INSTALLATION P-- REPAIRIADDITION I-I ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT 11 OUT-OF-SERVICE SEPTIC SYSTEM D DESTRUCTION e` INSTALLATION WILL SERVE: F-I RESIDENCE OMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: Q SEPTIC TANK TYPE=/MFG CAPACITY gal #0PARTMENTS D, GREASE_TRAP TYPE/MFG CAPACITY gal #0 ONIPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION it PRMt-RTY LINE 4 [� LIFT STATION SIZE TYPE OF PUMP ID PKG TX PLANT D SAND OIL SEPARATOR(ENCLOSED SYSTEW I LEACH LINES )(LEACHING CHAMBERS td OF LINES LENGTH OF LINES• ft fff )(LEACHING TO NEAREST WELL FOUNDATION ft PROPERTY LINE ff FILTER.BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE ft r MOUNDED WIDTH _ it LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft r SUMPS WIDTH ft LENGTH ft DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION it .1 PROPERTY LINE ft DISPOSAL PONDS WIDTH it LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl r-3 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROVERTY LINE_ ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAP!JOAQUIN COWATY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 HOUR ADVANCE NOTICE_ REQUIRED FOR INSPECTIONS-PLC-ASE CALL (209)99533-7697 SIGNED TITLE C�M,49� DATE/X /57 0 — -- ----- --- ti At I�EPARTP�F_A�T 'S GIVL �iApplication Accepted� Date—L7421 Area — Employee IL Final Inspection By Date q 0 ❑ SPECIAL PERMIT-Approved by T Character of Soil to Depth of 3 Ft: Pit Sump Soil Character: COW4ENTS 0 taltow &4+1 r Ve `�ipa :Tn� 1 0. PE SC Received Checkw Amount Permit/ Date Invoice# �ID# Code INTO By Cash Remitted Service Request # _ — --01 � TV yaG�-�•� OPI`'!rF WASr� PTMNTSYSTEM PERMIT