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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7637 FOR 1NSPECRONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jos ADDRESS R,04,0 CrrYILP <br /> CROSS STREET QQ /� APN V ?''� J`� / PARCEL SIZE <br /> OWNER NAME L PHONE , <br /> If <br /> OWNER ADDRESS CITYISTATEIZI.P <br /> CONTRACTOR bNl 1 / 1L0 <br /> CtAc PHONE ^�0 rJ <br /> CONTRACTOR ADDRESSC�ITY/S TATEIZIP��OC <br /> LICENSE ❑ -42 0!-C-36Y5aC� 7tXP <br /> 6 OTHER NUMBER (RATIONDATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION - ENGMEER DESIGNED)ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM L. DESTRUCTION <br /> INSTALLATION WILL SERVE: X RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: f NUMBER OF BEDROOMS' NUMBER OF EMPLOYEES: <br /> L3SEPTIC TANK TYPEIMFG tyf ST1 jA CAPACITY 981 #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY 981 #OF COMPARTMENTS <br /> DISTANCE TO NEAREST; WELL It FOUNDATICN ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP y❑ PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS 7 L bi4Wl�trS #of LINES LENGTH OF LINES It <br /> XDISTANCE To NEAREST WELL ft FOUNDATION��ft PROPER IY LINE 30 ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE it <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> CJ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FCUNDATION ft PROPERTY UNE ft <br /> SEEPAGE PITS NurasER .J. WIDTH YfL 1.9 ft DEPTH 1e ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION �� ft PROPERTY LINE_a, R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> INlMCf.WOTICEREQUIRED FOR 1N PE 2953-769 <br /> SIGNED TITLE rI DATE <br /> 109 ? <br /> SA <br /> ?0 <br /> p(11/y COL/tv <br /> MFNTq ANT y <br /> ARTMFNT <br /> I ]lit 4t <br /> n DEP M T. N Y r. <br /> Application Accepted By L Z, Dale /J n t' Area y%�i r Employee ID# r <br /> Final Inspection ByAA .((�'� - Data ��74' Q SPECIAL PERMIT-Approved by <br /> Character of Soil to Dbpth of s Ft P"y-iImp Sol(Character. <br /> COMMENTS l,'1k0<l j:' /Pl'S"f") bf (P ! Ir l ii r J1 <br /> E SCRecelred Cha Amount Data Permit/ Invoice# Permit ID# <br /> Code Iwfo lCa Remitted ice Re ue # <br /> _. _ ONSITE WASTEWATER TRTLINT SYSTEM PERMIT <br />