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1-6nP-tL o�74-L�0C ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDA13LLEyP^ERMIT CALL(209)953-769 FORINSPECTIONS ExPiRES 1 YEAR FROM DATE ISSUED JOB ADDRESS X77 u�y J CITY/ZIP r CROSS STREET L APN ✓ J-0 / PARCEL SIZE 1 y c # OWNER NAME_ <'•�`-rl� ) PHONE � ;7 OWNER ADDRESS 7/��37 aL�- ) CITY/STATE/ZIP } CONTRACTOR� fa / PHONE / Z-CONTRACTOR ADDRESS �iXJ/�4J� I7Y/STATFJZIP i LICENSE 1 "C42 L C-36 OTHER NUMBER 4 EXPIRATION DATE O`r WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinate$ X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEw INSTALLATION EPAIR/ADOITION ENGINEER DESIGNEDIALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION I INSTALLATION WILL SERVE: qi2lkRESIDENCECOMMERCIAL^� �j OTHER_ _ NUMBER OF LIVING UNITS: / NUMBER OF BEDL'ROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MPGJSff I.C.-! CAPACITY gal #OF COMPARTMENTS Ll GREASE TRAP TYPFIMFG CAPACITY gal #DF COMPARTMENTS DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE _TYPE OF PUMP .--_ 0 PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS _ #OF LINES LENGTH OF LINES V LIa t ft DISTANCE TO NEAREST WELL-1'O_R FOUNDATION_ i"lD ft PROPERTYLINE T=/ ft ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELLH FOUNDATION It PROPERTY LINE R ❑ MOUNDED WIDTH ft LENGTH It DEPTH R ,�/ DISTANCE TO NEAREST WELL fl =�OU}NDA-ION ft PROPERTY LINE R Ili SUMPS WIDTH-—1 ft LENGTHDEPTH ?S R I DISTANCE TO NEAREST WELL /b R FOUNDATION 1t PROPERTY LINE 'C S fI ❑ DISPOSALPONDS WIDTH ft LENGTH ft DEPTH R I DISTANCET^-'! .:nEST YVELL It FOUNDATION ft PROPFRTYUNE It SEEPAGE PITS Numimn I __ W.— -7 H DEPTH`_ ft DISTANCE TO NEAREST WElL_7 R FOUNDATION — ft PROPEP,TYUNE- 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 48 HOLIRUVANCENOTICE REQUIRED FOR INS�,- N/ PL 2 95,7-76971 SIGNED /��TITLE /'�'�� _ DATE I I it I I II II I I R q yM FcF �Hr r l I 1 f VFO III I ? i I ;IR;'��Y s � MFNT 0 E P A R T M E N T,U S Bf 0 N L Y Application Accepted B Date41, '�.w'w;t Area Employee ID# [�vI I SPECIAL PERMIT-Approved b Final Inspection By Date Y Character of Soil to Depth of 3 Ft: . PiV$ump$oilraCter , COMMENTS(—L,kNv-`'I /PC'S-✓? fPpe11 /t`1 PE SC Received Check#/ Amount Date PerrrW Invoice# Permit ID# Code INFO Cash Remitted $erYlCO R utiet 8 -010 12b 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <,1411E �DoT�7zq�7