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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 9953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED Joe ADDRESS —7(0-7 O E CIN/ZIP w A&rM C fi '?S-33 -) CROSS STREET rn IR 1yC r ` (Z 7• APN 2�] 1 �20 PARCEL SIZE /0 Tc D 0 _ a OWNER NAME ��V'N j T}'t C w IJ G' PHONE LV I Z - O(3 2- OWNER OWNER ADDRESS fitp-) J-) CITY/STATE/ZIP 1M^&rl-C c A CA `?S33 to CONTRACTOR L-N Lt `D(-'C%Z- G-EDy 1�a^/Y�'t E/�li�H L_ PHONE CONTRACTOR ADDRESS 4 D, w` C(,K S-T• CITY/STATEIZIP (--t7� ( Clot 'etS 2-40 LICENSE I. C-42 _C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # ( BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: - NEW INSTALLATION _. REPAWADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT II DESTRUCTION INSTALLATION WILL SERVE: I RESIDENCE I I COMMERCIAL I 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 It FOUNDATION ft PROPERTY LINE ft ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES - LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 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. IMUM 24 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNEDTITLE C o^-,.541 c-7-A--T- DATE S �0 E ver) 23 1010 SAI HE 1N COU qMENTA NTT gRTMENT PLY Application Accepted By, G �� DEP S Date E y 30 ZOZD C C /, I — Area 1 Employee ID*_ Final Inspection By K&14—"� Date � o❑ SPECIAL PERMIT-Approved by Character of Soil to D th of 3 Ft: Pit/stump Soil Character: COMMENTS trL PE SC Received hec Amount Date Permit/ Invoice# Permit ID# Code INFO ash Remitted Service Re uest# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT