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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CAS5202-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR NSPECTiCNS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS K CITY/Zip I y ` CROSS STREET - N 066-2-70 0 { PARCEL SIZE .�/'''> OWNER NAME •t PHONE 1 `- i iy�Js �. �o�h SA Co OWNER ADDRESS _vCITYISTA7E(ZIP 1 CONTRACTOR t -492,-/4044(' PHONE, Ar'E I}�'C N'•3o�`�"t(. CONTRACTOR ADDRESS CITY/STATEIZIP LICENSE ^'C42 z;C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # j BUILDING PERMIT _LAND USEAPPLICATION TYPE OF WORK: .: NEW INSTALLATION _— R£PAIRIADOITIDN ENGINEER DESIGNED/ALTERNATIVE j REPLACEME1I7 OUT-OF-SERVICE SEPTICSYSTEM DESTRUCTION 1f f INSTALLATION WILL SERVE: ❑ RESWENCe t_. COMMERCIAL E. OTHER ///''' NUMBER OF LIVING UNITS: _ NUMBER OF BEDROOMS- 1 NUMBER OF EMPLDYPPS: - }Q , SEPTICTANK TYPrjfAFG t'�TTL/l1ClA CAPACITY L�C)Lx 7 gal #OFCOMPARTMENTS 2- /❑_ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS i DISTANCE TO NEAREST: WELL ,� ft FOUNDATION— 6:� R PROPERTY LINE ,5:: ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENC L OSED SYSTEM) LEACH LINES LEACHING CHAMBERS #OF LINES - LENGTH OF LINES 7L0 fl DISTANCE TO NEAREST WELL Lft FOUNDATION U —ft PROPERTY LINE .-] ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It 0 WOUNDED WIDTH ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft J EI SUMPS WIDTH ft LENGTH It DEPTH ft } DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE R 5 ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft ,-,( � DISTANCE TO NEAREST WELL ft FOUNDATIOv _ _ ft PROPERTY LINE $ , Q"EEPAGE PITS NUMBER -7-- WIDTH ��[.&r J ~~- ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION F']] It PROPERTY LINE 'i 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, M! 1MUM 24 VANCE NOTICE REQUIRED FDR INSPECTIONS- YI EAST CALL f209j 9 3-76 7 — SIGNED TiT1E DATE ! _ ._ I -- _ -r- � i 1 -R-,a Sln I y0i•. �Y L� 1 j n z —� I ae X 4b �L J Le a 9 Hrr t 18 14 Y:w — — v — — — — — — - wo e G 1 .i_ 1 J i I I I I 1 I I I I I I I I ,1 DEPARTMENT SE ONi Y - -" Application Ar Date / �} _ Area Employee ID# Final Inspection — Date 1.1 SPECIAL PERMIT-AppIbved by Character of Soil to epth of 3 t.-_ Ptt/5um Soil Character: CdMMENTS eW !( 2 -Z'U k2reek17 �Ail Tc� 9�3 t� CIL-- — - L�FGr �t al PE Sc Received nill� Amount Date Permit/ Code INFO B Cash Remitted Service Request# Invoice# Permit ID# TT •12-0 f ±'#8t09 ONSITE WAST=-'.`,'A TER TRTbiNT SYSTEM PERMU"