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e3;o 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 Jos ADDRESS �3�I' !Y /`/TXw,. !'�I7 CITYIZIP _ _f Z Z.Z 7&\ CROSS STREET IC' I..D APN ��T C"- I ' G � PARCEL SIZE 17 e OWNER) NE 11:2t..s -S'f4q'•Q Oi )C PHONE J1. 1 I�f^Z 7-Z/ OWNER ADDRESS CJ I t (� )�1T}�c� �� CITYISTATEIZIP _C;176L 7l CONTRACTOR )I�i.,I;;T` 1,1��Iv✓t,K_I "k, PHONE CONTRACTOR ADDRESS _ Q4 Z S l PZ t4tc�T- k4,) CITYISTATEIZIP LICeNSE A/-42 QC-36 OTHER NUMBER Z EXPIRATION DATEy •_3I -3 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y C PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADDITION C ENGINEER DESIGNED IALTERNATIVE 3C REPLACEMENT cf.1 C M r'.f wJ Q OUT-0F-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE 0 COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: H NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPFJMFo CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPFJMFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNOATICN ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKGTX PLANT ❑ SANO OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES 0 LEACHING CHAMBERS #OF LINES LENGTH OF LINES C it W DISTANCE TO NEAREST WELL �� f ft FOUNDATION it PROPERTY LINE it ,? ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE it ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft J DISTANCE TO NEAREST WELL .t FOUNDATION ft PROPERTY LINE It ^ ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft C) DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ DISPOSAL PONDS WIDTH ft LENGTH it DEPTH ft Z DISTANCE TO NEAR T WELL ft 6,FOUNDATION It PROPERTY LINE ft -1 13SEEPAGE PITS NUMBER WIDTH W7 It DEPTH 2.S/ ft DISTANCE TO NEAREST WELL_ZaIL 4 It FOUNDATION it PROPERTY LINE ti I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, fQ STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. J MINIMUM 24 H UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE �Mn�G�rt'C DATE tO-� —�.3"/? _. F-7 1 Y i I Ii ��I LY r -i DEPARTMENT SE.ONLY Application Acce �Y? , Date 2 2� Area Employee ID# f-0Final Inspection Bi Date ❑ SPECIAL PERMIT-Approved by Character of Soll to D pth of 3 Ft: PiVSump Soii Character: COMMENTS &D �Z ,�FS't<n PE SC Received fChock#1 Amount Penniv Code INFO B s /I emitted Date Service Request# Invoice# Permit ID# j'�CiUG>`k'4 z7 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 9121110