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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 1 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS O t-- C�IT�Y/L-M CROSS STREET _ �APN� w_ 1 PARCEL SIZE 44 ' c OWNERNAME T��7 pq�' .IL1-'�OrN y+F , y� PHONE (yam OWNER ADDRESS ta _t3 1 [.y}1.sq�b LCV F?j�,Jc� �.�CITY/STATE/ZIIP(�[ Y�YyI-�V� cb, CONTRACTORS (lo j�v PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE C42 C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDIN _G PERMIT# X1-70 � LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION R AIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE LI COMMERCIAL 1-1 OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG _ CAPACITY gal #OF COMPARTMENTS p GREASETRAP TYPF/MFG-,T`AS al CAPACITY 15 E) gal #OFCOMPARTMENTTS^t`+ DISTANCE TO NEAREST: WELL �- It FouNDATION `G ft PROPERTY LINE 1 1p I it ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OFLINES ft DISTANCE TO NEAREST WELLit FOUNDATION _ _ _ _It PROPERTY LINE It ❑ FILTER BED WIDTH it LENGTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft ❑ MOUNDED WIDTH it LENGTH _ ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft ❑ SUMPS WIDTH it LENGTH ft DEPTH It DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY UNE.._ It ❑ DISPOSAL PONDS WIDTH. it LENGTH h DEPTH _ — It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ SEEPAGE PITS NUMBER WIDTH _ It DEPTH_ it DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPEN ION LAWS. MINIMUM OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-71619 SW,IED — - TITLE DATE_ Dr CFO n0 WA r �j Q Yv M R. P Application Accepted By Data Are, (, / Employee ID# �6 Final Inspection By Date SPEC[[[IAL PERMIT-Approved by Character of Soil to De of 3 F. A f Pi Sump 4611 Character: COMMENTS r 1n.1 - W f {g ISG PE SC Received Amount Date Permit/ Invoice M Permit I Code INFO B ash emitted Service R uest N T081 'AWL 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 515117