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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS �O �L��Z..I��U CITY/7JPC,�TU� �i \\ �- - l a CROSS STREET_ll�'�3�C3C7 APN 3��Q PARCEL SIZE 1` p OWNER NAME �� .5.��l��L�4�` �l`-� .��P�H�O�NE Z�l-,(-1 --\\.01p OWNER ADDRESS \--I \ \mi- �M` A'fZC'-\.<� /lWr_-/ / CITY/STATE/LP��ILl-- +("_ L'T'SZJ7 n CONTRACTOR N\�`74-�� !->A 1- A L'Jtr AV. � I W..- PHONE Zif CONTRACTOR ADDRESS �� F- �^^w�`c- C�— CITY/STATE/LP 'MJS�LQ.-�i-D C-^ LICENSE LI C-42 11 C36 OTHER C-'L-L NUMBER 2-Z t\`p w EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y— FPERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM J& DESTRUCTION INSTALLATION WILL SERVE: I I RESIDENCE I COMMERCIAL L OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPEIMFG 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 I LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH It LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH it LENGTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE 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. 48 HOUR AQVANCE NOTICE - �I SPECTIONS-PLEASE CALL(209)953-ZO9- SIGNED TITLES!«Sf--`Z— `N TE c M�Nr EiVEQ ?019 EPARTif NT PA R TMEN T4!SE,0NjLY Application Accepted B Date Area Employee ID# Final Inspection By 1�\ Date '-7 J fl �'PA\ L' SPE 1AL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character. COMMENTS Pf� zuMnm4 7 e� - L�l/VE. v F M L, L C CNi PE SC Received Check Amount Permit/ Code INFO 8 Cash emitted Date Service Re uest# Invoice# Permit ID# 1 will 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14118