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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 209 953-7697 FOR INSPECTIONS .r pA EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS XS-'l Z- S. t LL(S Ale. CITY21P I "�I S 3,1 CROSS STREET Grl SCGIC APN Z-fy - r30- D1 PARCEL SIZE 1.44 A D 0 OWNER NAME 'D&%l Int D�'L SI$fdrkf —PHONE—U.31 pHOLNE Ca 31 OWNER ADDRESS I f94 W1LDR VWl !AA" CITY/STATE/ZIP �t-'►„V CA 4'S CONTRACTOR V(J t P Pru GC-D IV V IIP O N V%C'0-J ML PHONE 3(05-0 31 S CONTRACTOR ADDRESS L+01 W- 0 AX ST• CITYISTATE21P L-O A I CA rf S- t L4 O LICENSE I IC-42 IC-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAWADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL _ 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 G '"WENT LEACHING CHAMBERS #OF LINES LENGTH OF LINES R C IVE DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft D ❑ FILTER BED WIDTH ft LENGTH ft DEPTH / DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ,JfY►"/ 112020 ❑ MOUNDED WIDTH ft LENGTH It DEPTH CA a,ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINEO QUIN 13 SUMPS WIDTH ft LENGTH ft DEPTH HEaI�!N NMENICOUNTY DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft DEPARTII�ENT 13DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft L3SEEPAGE PITS NUMBER WIDTH It DEPTH It 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. N MUM 24 H DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED / TITLE P�3 Wl CSR . DATE 11-I I C> DEPARTMENT SE NLY p Application Accepted Date // J.I I) Area 1 Employee ID# 5 K Final Inspection By Date SPECIAL PERMIT-Approved by Character of Soil to De th of 3 Ft: Pit/dump Soil Character: COMMENTS PE Sc Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO Remitted Service Re uest# yaaa Sa3 is 3 S 2l 42-Ot ONSITE WASTEWATER TRTMNT SYSTEM PERMIT