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R 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'I YEAR FROM DATE ISSUED JOB ADDRESS 1 -7 3 9 C LE-M t k/7-5 CITY2IP Ly D( 9 S 2�-L P qQ' � CROSS STREET BRIArN'DT APN D/ 1 Zp0O_ V PARCEL SIZES .3.0 • p9 OWNER NAME DENN S GCDRCrFt Tl73 C 3QENT WO(LKr►'IEb�!PHONE Qy_ •�ZI Q.p t- Q H OWNER ADDRESS `1 5(P o ,C • / �ZM'-M 790 N{T CITY/STATEIZIP L..OD 1 Cts �2 5 2q 7- CONTRACTOR (--(y Cf.�O 1I `� ��'py, y��r�- N L PHONE 3bR-031 5- CONTRACTOR ADDRESS •O-i w• o `K •-' • CITY/STATE/ZIP �O✓ ( C� •T2-4o LICENSE _.C-42 C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y )C PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: i.. NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT .. DESTRUCTION INSTALLATION WILL SERVE: J RESIDENCE COMMERCIAL I 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 LEACHING CHAMBERS #OF LINES LENGTH OF LINES r' DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ FILTER BED WIDTH ft LENGTH it DEPTH ,��•• DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE IA— ❑ MOUNDED WIDTH ft LENGTH It DEPTH /R DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft 2018013 $UMP$ WIDTH ft LENGTH ft DEPTH �{ DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It 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. INIMUM 24 UQ4,4RR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 SIGNED I ✓` TITLE GO NSU l--T ^4r- DATE DEPARTMENT U •ON Application Accepted By Date14 Area Employee ID#— K% Final Inspection By Date ' SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS lits- ^«tom- / .5 ee a{�._ /�•.�_ �Cg E� PE SC Received a Amount Date Permit/ Invoice# Permit ID# Code INFO B ash Remitted Service Request# 157 i Ip -S4tul Ou 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT