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i 1 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN,UOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468.3420 N'N-REFUNOABLE PERMIT CALL 209 ^953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOD ADDRESS yq„1,'S S• �r�' U 12D Crry/ZIP C-A- CROSS STREET V fa APN � -�-, 2-1 PARCEL SIZE OWNER NAME G I 1^, __PNONE ^-1 I A•- A 2S S OWNER ADDRESS A, CRY/STATNZIP Y• CONTRACTOR 1,Y) IGG. p ,�GNJC 4!1,-- a-'ci- PHONE j:jti[iJ`rY'it' CONTRACTOR ADDRESS 40 6-x CITYISTATEIZIP M qd iG4 i�-J► ' I LICENSE I~C-42 QC-36 OTHER ' NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y 7 PERC TEST # BUILDING PERMIT# — (70 LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION ] REPAIR/ADDITION J ENGINEER DESIGNED/ALTERNATIVE C REPLACEMENT ] OUT-OFSERVtCE SEPTIC SYSTEMJDESTRUCTION INSTALLATION WILL SERVE: IC RESIDENCE ❑ COMMERCIAL G OTHER i NUMBER OF LIVWG UNITS: NUMBER OF BEDROOMS; J NUMBER OF EMPLOYEES: P-1—SEPTIC TANK TYPE/MFG Q¢I GJft GJ—F-ei CAPACITY �-n gal #OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL D ft FOUNDATION I a I fi PROPERTY LINE '3O I ft ❑ LIFTSTATION SIZE TYPE OF PUMP a PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES ❑ LEACHING CHAMBERS �j #OF LIN S / LENGTH OF LINE I It DISTANCE TO NEAREST WELL CSS ft FOUNDATION I0,T it PROPERTYU K 4 ❑ FILTERBED WIDTH ft LENGTH ft DEPTH ft +- 09STANCEToNEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft CI SUMP$ WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FCIJNOATION ft PROPERTY LINE ft a O DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH DISTANCE T kEAREST WELL ft OUNDATION ft P PERTY LINE ft Y' 1J' SEEPAGE PITS NUM6ER WIDTH ft DEP ' ft \UU DISTANCE NEAREST WELL t FOUNDATION J �ft PROPER NE—,3n---ft lU � TilU HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATBE PONE IN ACCORDANCE Mrll'N SAN JOAQUlN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. I l MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953- 697 SIGNED 6� TITLE CQ11-a t4G l- T DATE 1 1, CL *7 + I � I i I i a3 y DEPARTMENT'- SE;' NLY'-- - Application Accepted B - — - Date (0 Ig D Area rEmployee ID# n �q Final Inspection By Date 2ZA4/O ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of Ft: P' Sump Soil Character: COMMENTS OLO Z o o %, / PESC Received he Amount Pe= Code INFO I B Cash Remitted Date Service uest# irnoice# Permit ID# �I2(f 117 14q73.o01 J-116Q 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 8!28709