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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 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS Q Z'�0 IV• (, HoI L.t>XCS 5 oa:n CITY/ZIP STd C.k-Tu-rj gS'Ll 1 v' CROSS STREET 2V1PkL_L.EE)2 APN )�-Z� v 3y / PARCEL SIZE I•3 • C o OWNER NAME 0 0"r'4G 12 PHONE �(•��S-7 1 OWNER ADDRESS so-KA CITY/STATE/ZIP A CONTRACTOR U \��Vt- 0' � Gt�L�IJ V�QO�Y�'�t IVT' �- PHONE -3(P • X03�� CONTRACTOR ADDRESS 4 J 1 w• OAK- &-T-. CIN/STATE/ZIP LV t1 I ILA q rA--'�D LICENSE ..IC-42 .0-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: :_ NEW INSTALLATION REPAWADDITION ENGINEER DESIGNED/ALTERNATIVE .. REPLACEMENT .. DESTRUCTION INSTALLATION WILL SERVE: I I RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES L LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ FILTER BED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft ` FD DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft A ❑ SUMPS WIDTH ft LENGTH ft DEPTH fF/ 13020 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 1h ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH v/ COIJ DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH /y�N DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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. INIMUIMM/Nl HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED I— ` TITLE C-0w.5✓t-T/1-^j DATE I `ZI ZIP L• LTI I I I I L 11 1 IF D DEPARTMENT SE I . Application Accepted B Z Area 2 Employee ID# Final Inspection By DaDate te L SPECIAL PERMIT-Approved by Character of Soil toRRepth of 3 P' ump Soil Character: COMMENTS Yk4Y— • 2 Inc l PE SC Received Check Amount Date PermiU Invoice# Permit ID# Code INFO Remitted Service Request# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT