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ONSFE WASTEWATER TREATMENT SYSTEM PERNT SAN JOAQUIN COUNTY ENVIRONMENTAL FIEAI_Tli DEPARTMENT 1868 E.HAZELTON AVENUE-STOCI<TON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT / / CALL 209 953-7697 FOR INSPECTIONS EXPIRES�1^ YEARFROMDATE ISSUED JOB ADDRESS 0 l� C.4C1'� M gor CITY/ZIP /� -,14. G4 t-✓/. ( ��3 f:(j a `, f� M CROSS STREET Rdt,;,y �� APNa/ZT/�� O�C�+ l� PARCEL SIZE d OWNER NAME 'J©t-y 5 � c��I �,(f°?�/LL� AY��i rt y PHONE_ OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR+rTL_t 5 , 7�eC 5+ L- PHONE_ P,/� CONTRACTOR ADDRESS Po eo& � CITY/STATE/ZIP LI �CAi,&C.69-1,C t LICENSE ❑LIC-42 0IJC-36 OTHER NUMBER EXPIRATION DATE �c3.n r1 WATER TABLE DEPTH:. 3o'H0 ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# 14CO LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION 0 REPAIR/ADDITION 0 ENGINEER DESIGNED/ALTERNATIVE El REPLACEMENT fl OUT-OF-SERVICE SEPTIC SYSTEM 0 DESTRUCTION INSTALL AT[ON WILL SERVE: ❑ RESIDENCE_ I COMMERCIAL OTHER tai NUMBER OF LIVING UNITS: n i NUMBER OF BEDROOMS: �A NUMBER OF EMPLOYEES: J W'SEPTIC TANK TYPE/MFG r\ CAPACITY [�pgal #OF COMPARTMENTS rL U GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS 1 DISTANCE TO NEAREST: WELL ft FOUNDATIONI ft PROPERTY LINE ZS-I ft © LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT Q SAND OIL SEPARATOR(ENCLOSED SYSTEM) EACH LINES ❑ LEACHING CHAMBERS #OF I-INES LENGTH OF LINES iO ft DISTANCE TO NEAREST WELL_ Os7 t ft FOUNDATION_e ft PROPERTY LINE. ft U FILTER BED WIDTH _ ft LENGTH ft DEPTH ft DISTANCE TO NE=AREST WELL ft FOUNDATION ft PROPERTY LINE ft U MOUNDED WIDTH ft LENGTH_ ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft C�1 SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft © DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft �J SEEPAGE PITS NUMBER WIDTH ft 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. MINIMUM 48 HOW? 1)VANLZ WOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE �c� ST DATE I t7 67 Jq 01 N DF_PARTMENTUS ONLY Application Accepted By Zr� z-z— Date � P a70o7b Area 3 _ Employee ID# S� Final Inspection By grMnQ_ rn Date -+j'3 'a0X0 ❑ SPECIAL PERMIT -Approved by Character of Soil to DeTpth of 3 Ft: Pit/Sump Soil Character: COMMENTS S S*rm !h5 Si2e6f uIrjn ple4n tev)ei-J rof L01,101+n er i . 4 si h Si2e0� +,m ,nd, ardlyhy,5 1Ve o{-Ci ce. Wafa' nerds ,F'; 1 f46 0 PE Sc Received C Teck Amount Date Permit/ Invoice# Permit ID# Code INFO By Remitted Service Request# ya16 iso �Sa 3d 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14118