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`LIQ ONSITE WASTEWATER TREATMENT SYSTEM PEMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3A20 BION-REFUNDABLE PERMIT CALL_ (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED Joa AwFmss U) b/f.&,r M/Ir 90 CrrYFZwo 2 R _ CRO Z STREET 19 f/lCfG7�✓ APN — PARCEL SIZE. 2_ e j/ �• C OWNER NAME M PHONES OWNERADDREw l��D A/��_ m,6#r ottlir oel) CITY/STATEMP !;M L ILK CONTRACTOR_ S fnt04- LQ{R� �J AL PHONE I J CONTRACTOR ADDITESB - r // y ?�-E 0 � CITYISTATEMP � S LICENSE J�JC f-42 UC-36 OTHER NUMBER / EXPIRATION DATE WATER TABLE DEPTH: ft GEoGRAPHK:AL INFORMATION: Coordinates X Y ❑ PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: L NEW INSTALLATION a REPAIRIADDrt1ON ❑ ENGINEER DESIGNEDIALTERNMWvE C RLPLACEMENT C DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL L) OTHER NUMBER OF LNING UNITS: NUMBER OF B ROOMS: NUMBFA OF EMPLOYEES: O SEPTIC TANK TYPEIMFG CAPACITY g?J #OF COMPARTMENTS 13 GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft O LIFTSTATION SIZE HYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES Il LEACHING CHAMBERS #OF LINES+�� LENGTH OF LINES ft ft DISTANCE TO NEAREST WELL It FOUNDATION `(�% '+ ft PROPERTY LINE_ ft O FILTER BED WIDTH ft LENGTH _ft DEPTH ft DISTANCE TO NEAREST WELL _ ft FOUNDATION_ ft PROPERTY LINE ft O MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION_ ft PROPERTY LINE ft O SUMPS WIDTH ft LENGTH_ ft DEPTH ft DISTANCE To NEAREST WELL I t FOUNDATION ft PROPERTY LINE ft 0 DISPOSAL PONDS WIDTH ft LENGTH_ ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft O SEEPAGE PITS NuMaeR WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL. ft FOUNDATION ftPROPERTY LINE It 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. 2 H ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE _ �IbA— DATE 3 , P, All t- A M E k IOf 6 G v 1 11'**+* J � RE TMwiwttSump Application Acwpter ateArea Employee 0# Final Inspection Bf Date ❑ SPECIAL PERMIT-Approved by_ i Character of Soil to pth of 3 Ft: Character. COMMENTS 1*a-j R/ S PE 2C Received CiwaW Amount Date Permit/ Invoice# Permit ID# Codo INFO BY ,ca-sh, Remitted u ,t, G i S5L419'S A� I�Sb'J lu7ry �lv N ►/S�/19�1rn1� l,�J.ir162. (4 3e- /o�{/ fir'r ,c�)Jc�'7iG 1G3e1T�k u`+►� ' ?f�t .4 Jr fjf.j/tee.Fae;u7�, ONSITE WASTEWATERTRTMNT SYSTEM PERMIT 10/4ID7