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l <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SA14 JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL f2D9)933-7697FOR INSPECTIONS EXPIRES 7 YEAR FROM DATE ISSUED <br /> ,y —y � ..a rrYrz,P__ j. <br /> ..3C�R AD0RES5 .."" <br /> CPOSSSYAEET ,$- __3.3 _. _ _._.._APR_..S.�3s3 ��..3.-f -�_.._.__-_.PARCEL Sa V <br /> OWNER NAtdE_��>gy} ............._�.....__. ._..��.__.1.1�J�� ....__ P vU' <br /> OWNER ADDRE5S.Z6k ��3fl✓�?'�.___ _CiTYISTATEIZIP _ <br /> CONTRAC OA_ w tL•il. .,�J y ._� __.__ .31.L.i..�--PHONE._..__ ..`,y - <br /> a� CITYISTATEIZIP _ �-✓� <br /> CONTRACTOR ADO12ES8 46M_ ....._._ t�--..-_„_.. --...__.. <br /> I <br /> iICENSE J.C-42 C-36 OTHER_.._. ,.._ NUMBER ..EiCP1AATiON DATE - <br /> WATER TA9Lf DEPT'N:, ,..._.__._.___....._..._....... III GEOGRAPHICAL INFORMATION: Coordinates X.._,._.,_.,_...- Y. <br /> Q] PERC TEST tBUILDING PERMIT#._ _LAND USE APPLICATION# <br /> PE OF WORK: 0, NEW INSTALLATION REPAiA1AD27l7713ld ENGINEER DESK NED <br /> i>>> <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM :7 DESTRUCTION _ <br /> i iNSTALLATION WILL.SERVE: y RESMWE U COMMERCIAL U OTHER, SA 4l a <br /> 3 NUMBER OF BEDROOM. NlilABER OF <br /> i NLSJIaER OF LIVING tiNrTv:.._..� -' �y <br /> 3 SEPTIC TANK TYPEWFG ___ CAPACITY gal N OF C,OMPAATtaE l� <br /> 3 GREASE TRAP TYPE/IMFG ,,,_ CAPACITY -_-_ gal V OF COMPARTMENTS <br /> DISTANIM TO NEARM: WELL ft FOLMATION R PROPERTY LINE ____-__._...-it <br /> ?3 LIFT STATION SIZE _ -TYPE OF PUMP-----LI PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> aa�� � ti �_ <br /> LEACH LINES 'i LEACHiNGCI9Abi8£RS�...yf_T. ......._...._.....__. LENGTH OF LINES <br /> _.._...--- <br /> OF LINES <br /> DISTANCE TONEAREST WEU. .... it FOUNDATION__-.-it PROPERTY UNE <br /> C! FILTER 8E1) WIDTH it LENGTH— ft DEPTH <br /> it <br /> DISTANCE TO NEAREST WELL___- (1 FOUNDATION It PROPERTY UNE it <br /> Q MOUNDED WWH _ R LENGTH-----ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE R <br /> 3 SUMPS WIoTm ..__..- h LENGTH.------ It DEPTH It <br /> DISTANCE TO NEAREST WELL it FOUNDATION—t' PROPERTY LINE it. <br /> DISPOSAL PONDS W3OTH _ _ _ ft LENGTH—_._._ R DEPTH 8 <br /> DISTANCE TO NEAREST ELL__,,.._.._..........._....ft FOUNDATION ___. R PROPERTY UNE.,_.__ -- <br /> it <br /> ' SEEPAGE PITS Nth—. ._ WID _ __ <br /> it DEPTH -ft <br /> _ �f'y� <br /> DISTANCE TO NEAREST WELL' __._ tt FOUNDATION..-. <br /> Nu !t PROPERTY UNf 'SJ” - ft <br /> I HERESY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND p.Lr ULATIONS OF SAN JOAQUIN COUNTY. <br /> ► HOU D E' JF?ED FOR I C-40N - L ASE CALL 209 3- 97 <br /> _..... DATE...._..... _... ._.r.-.._.. <br /> 1 ... TITLE- - __.....___.__.. <br /> SIGNED _.__ _..._... ._---....._. ....... ---....... <br /> 1 <br /> 1 <br /> j <br /> 1 <br /> Y <br /> I <br /> All <br /> I h` <br /> AA M� U F <br /> Application Ac Date . ;. Area <br /> Data /. D SPECIAL PERMIT-Approved by <br /> Final inspection 8 - --.... <br /> Claracter of Soil to D at 3 ._. ._-_.._.._.-.......___.,..._................. Pit/Surnp Soil Character. <br /> i-' PE SC Received Chao Amount bate Parmw Invoice V Permit ID# <br /> Code Ir" BY. ca"611 Remitted Service Request <br /> 0 10 <br /> IL <br /> �- ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 42-01 <br /> 4t2Aft2 <br />