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OWN ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 6631 South Jack Tone Road CmIZIP Stockton,95215 u. a CROSS STREET Mariposa Rd. APN 181-080-170 PARCEL SIZE 1.19 D v OWNER NAME Dennis Faist PHONE(209)639-1581 OWNER ADDRESS 6595 South Jack Tone Road CITY/STATEIZIP Stockton,CA.95215 CONTRACTOR TB.S West PHONE(209)652-7811 CONTRACTOR ADDRESS PO BOX 1592 CrrY/STATE/ZIP Linden,CA.95236 W LICENSE I C-42 C36 OTHER A&B NUMBER 939001 EXPIRATION DATE 10/31/202�1 WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X ��l• I~�v`�Y 7�. I I I PERC TEST # BUILDING PERI # LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/IAA TERNNATrVE/ REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION {� (1 INSTALLATION WILL SERVE: RptDENce COMMERCIAL OTNeR llyl_� NUMBER Of LIVINo UNRS: /^ NUMBER OF BEDROOMS: NUMD[R OF EMPLOYEES 0 SEPTIC TANK TYPEIMFG ! /V C.,/�JG CAPACITY -7a d gal #OF COMPARTMENTS_ Y1 ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL R FOUNDATION it PROPERTY LINE it ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) J LEACH LINES LEACHING CHAMBERS #OF LINES I LENGTH OF LINES 3b It DISTANCE TO NEAREST WELL /DrJ it FOUNDATION ft PROPERTY LINE -7A it ❑ FILTER BED WIDTH it LENGTH ft DEPTH ft ' (J DISTANCE To NEAREST WELL it FOUNDATION it PROPERTY LINE ft ❑ MOUNDED WIDTH It LENGTH ft DEPTH it DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH R LENGTH ft DEPTH /t DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE it ❑ DISPOSALPONDS WIDTH ft LENGTH it DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION it 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. ^` C I 48 VAN N C IN�p/Z1.L0 3-7 1�- SIGNED /�— TITLE !/ (1L ,41111.Qf DATE '1//�.tS ZO "1 pqAmYM FcFj�NT R FD ?? �� o lj/N c 4 A17 N� DEPARTMENTJUSff ONLY y� Application Accepted y! ` Date Z �z-d Area r �C Employee ID# i/A Final Inspection By Date Z�� SPECIAL PERMIT-Approved by Character of Soil to eoth of 3 Ft: G Pit/rump SqV Character: CO ENTS :Yl.+r, CD4kIi�/O44' -�rC �G�tYL C S Alt M Tec�,�- +-ea� PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO B ash Remitted Service Re uest# zz ops #Isa 22 w 5►20 4/141 � 078-09 3 / ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/1B `(J/ (/lJ(v (/