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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT S AN J DAOU I H COUN7Y ENVIRONMENTAL HEALTH DEPARTMENT 1968 E.HAZELTON AVENUE-STOCKTON CA 95205-[209]468-U20 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS ExPIRES 1 YEAR FROM[TATE ISSUED JOB ADDRESS -2-5- pyo 1 W. F L fp�►�T I pj> r CRYIZI,p 7Tj?+I,1,,v=-y y,� CROSSSTREET _ yr•L� _,- APN Z l�^' V v Q rP+A-RSC ErL SITE 312G�,At- b OWNER NAME MLC r1&C- &I LVID} PHONE SLV4'S�p 1 � N OWNER ADDRESS Z 9-or-> MA N Cy5 C"/STATFILIP T -f-- C A 9 S-3 C 4 CONTRACTOR L-t►IC 0 - GED F.&j d1Rz>rDmEru i A-L PHONE 3L+'1- ❑'S 5 CONTRACTOR ADDRESS 1+071 w• O AK ST C1r1/ST-'-1F JP +-ate 1 CA S -4 p LICENSE ❑❑C-4x ©❑C�36 OTHER__ CcU _ NUMBER 4-1 V I EXPIRATION DATE q WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: COordln3tes X Y PEFIC TEST N BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION ❑ AEPAIRIADOITION ❑ ENGINEER DMGNED/ALTER NATIVE REPLACEMENT ❑ OUT-0 FSERV ICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILLSERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVIND UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OP COUPARTMENTs ❑ GREASE TRAP TYPERNFG CAPACITY gal #0FCOMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft (3 LIFT STATION SIZE TYPE OF PUMP ❑ PKGTX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) U LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES if DISTANCE TO NEAREST WELL ft FOL)NDATON ft PROPERTYUNE R ❑ FILTER BED WIDTH R LENGTH it DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATON R PROPERTYUNE R ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE To NEAREST WELL tt FOUNDATION fl PROPERTY LINE ft R SVMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLiNE ft U DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTYUNE ft C] SEEPAGE PITS NUMBER WIDTH ft OEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTYLINE It I HEREBY CERTIFY THAT I HAVE PREPAREA THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES. STATE LAWS AND RULES ANO REGULATIONS OF SAN JOAOUIN COUNTY- MINIMUM R AQVANCE NOTICE REQ UIRED FOR INSPECTIONS-PL ER E CALL 2 2 zo 7 SIGNET] � TTfLE r R'B�.I• ►'K(7,�. DATE Cf •q-Z� ZZ ep Fjy� T D ?0?0 �FNT OEPAfTTMENT U E ONL Y n Application Accepted By —,z?Z-Z— Date 4 O O ZO Area Employee ID#�DA Final Inspection By Date D SPECIAL PERMIT-Approved by Characiv of Sail to Depth of 3 F3: Pit'S urn SolI Charac ter: COMMENTS PE SC Received It Amount Qate Perrnitl InV4iC8 s Permit IDN Code INFO h emitted Service R uest N 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 411417 B