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ONSITE WASTEWATER TREATMENT SYSTEMA PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3424 NON-REFUNDABLE PERMIT CHILL f 209 9,,5/37697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 2q00 JE( '� Irk Lti' LCITY1zP�f 7 c 52� y CROSS STREET le r_ omeg/ Is APN �y i PARCEL SIZE y OWNER NAME g_ C"..�'TC 1 ��! r �� 6;L PHONE �OWNER ADDRESS '� 18 2 n `� �CITYISTATEIZIP d-7� '� c 916&2. CONTRACTOR 1 el 4-r `� PHONE Vcq 46 r r t &� � CONTRACTOR ADDRESS ;2,VQ • eA4P Y D'j 64 &,I CITYISTATEIZIP ci &S c) / LICENSE ,C-42 IjC-36 OTHER NUMBER 71636-? EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X D PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: 0 NEW INSTALLATION 7 REPAIRIADDIT{ON ❑ ENGINEER DESIGNEDIALTERNATIVE ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM D DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE OMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: Q ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS GREASE TRAP TYPEIMFG a It I-Z-VtS"A 1 CAPACITY 3Lb� gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL A"Al- ft FOUNDATION (fG ft PROPERTY LINE ft LIFT STATION SIZE 1�1APE OF PUMP E PKG T%PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES Id-b ft DISTANCE TO NEAREST WELL ft FOUNDATION ( :; It PROPERTY LINER ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE n ❑ MOUNDED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ElSUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE JT'y SEEPAGE PITS NuMBER Z-`j ft � ft DEPTH ANCE TO NEAREST ELL ft FOUNDATION ft PROPERTY LINE elft I HEREBY CERTIFY AT I HA PREPARE PPLICATIO AND HE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, T LAWS AND LE D REGULATIONS OF SAN JOAQUIN COUNTY. MINI UM H V E UIRED FOR INSPECTIONS- PLEASE CALL 209 953-7697 SIGNED TITLE tJ DATE d S . - &7"l nf. 1 , 0 0 GGLgCQ. v r'" off' `, 71/ rr 4 E T L f7 H DEPARTMENT USE QNLY �r Application Acce to ' Area Employee ID# Final Inspection Y - ' ' Data El SPECIAL PERMIT-Approved by 2 If Character of Soft to Djj5ih of 3 Ft: Piti ump Soil Character: COMMENTS S � �7/ni':{� �I - � " �✓�'G�LI,�''C¢' , PE Sc Received Check# Amount Date Permit! Invoice# Permit ID# Code INFO B Remitted I I Service Request# 2 l z (1�t� ?s � 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 9121!10