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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN CDUN TY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTDN AVENUE-STOCKTON CA 952CS-(209)466-3420 <br /> NON-REFUNDABLE PERMIT CALL 209,{953-7697 FORINSPEC770N8 EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS >� /?l/� CRYZP ' <br /> CROSS STREET APN �S�i�U�1Y PARCEL SIZE6 J~ r <br /> OWNER NAME PHONE &YU ;�627_ <br /> C OWNER ADDRESS CITY/STATE/ZIP <br /> ' -s <br /> CONTRACTORPHONE <br /> -� 12:�0 ! Ci��J C'-. C7 Z. <br /> CONTRACTOR ADDRESSLUT✓ A'V //Ig !�� CRY/STATEIZIP <br /> LCENSE A-42 _ C-36 OTHER NUMBER v EXPIRATION DATE 0 <br /> I <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> -_ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION P< REPAIWADORK)N ENGINEER DESIGNEDIALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: Irn RESIDENCE COMMERCIAL I.i OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER Of:BEDROOMS: , NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEtMFG !a771h CAPACITY <br /> gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPiII CAPACITY gal #OFCOMPAP.TMENTS <br /> DISTANCE TO NEAREST: WELL H FOUNDATION It PROPERTYLINE f: <br /> ❑ UFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES`�_ LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL f ft /FOUNDATION /S­ ft PROPERTYLINE 7j'_ /j' fl <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION It PROPERTY LINE fl <br /> ❑ MOUNDED WIDTH It LENGr' ft DEPTH H <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SUMPS WIDTH_ It LENGTH f ft DEPTH <br /> / DISTANCE TO NEAREST LYcLL.�72 ft FOUNDATION ft PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH fl <br /> DISTANCE TONEAREST WELL it FOUNDA71ON It PROPERTY LINE fl <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE To NEAREST WELL It FOUNDATION R PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> MINIMUM 48 HOUR NOTICE IRED EQB INSPECTI (209) 5 -7 7 <br /> SIGNED _. TITLE J _ DATE �0��4 <br /> l l lie it ! i f <br /> / 1 1141 1 <br /> I I I I ! I I f <br /> I <br /> 4,0,9 3� FCG <br /> TyOop CO <br /> �NPr <br /> FNT <br /> i <br /> i EPARTM N musi ONLY <br /> �C7 <br /> Application Accepted By=— �� Date °jp� �` Area Employee fp# a <br /> Final inspecTlon By Data 10Z ;.l SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Fr- PkfSump Soil Character: <br /> COMMENTS 19 ; Vy1 Iec!6011 2Y ♦`Ir, .%r,:' �'4 I•,Y� '1 'L� •,rN,.� • P! n/j� <br /> /4o i;,st,Jy 5F ��:�1+./eixls�iyt� sl jaF,n�l .� r�t,irnc is <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B r aah RemittedDate Service Re uest# Invoice# Permit ID# <br /> _ I - <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 <br />