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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 1 CITY/ZIP LOCH1 AD CROSS STREET ll l flit l�7 Y-�� APN ()'qa DO?U11�1 PARCEL SIZE 3,t6� OWNERNAME �� tl�/�A�'AS clDp enytlS j�PHONE ID "LV52-! OWNER ADDRESS`t�Ixc7`T1(^1Lolest f�IRy��tl/le/�v1tv,I NYCE Tp2�ITYISTATEIZIP'J _t,��{Bfl Wr C'] � U CONTRACTOR— Y\JI�s_ 1 l.lwA -r y�L'4--1 i ��I C PHONE Z C) 1 ' /✓•}3/,q /(,3�''Cq CONTRACTOR ADDRESS 3.l' rnL.YVVj I) S CITY/STATE/ZIP 'Z6147,I2(�/-I LICENSE -.C-42 Ch-366��OTHER_ NUMBER 85+►5-7 EXPIRATION DATE .L0z3 WATER TABLE DEPTH: I-/® ft GEOGRAPHICAL INFORMATION: Coordinates X Y C PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATKJN _. REPAIR/ADDITION _ ENGINEER DESIGNED/ALTERNATIVE REPLACEMEN OUT-0F-SERVICE SEPTIC SYSTEM _ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE r COMMERCIAL ❑ OTHER -/ NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: i�q ` NUMBER OF EMPLOYEES: /J �T SEPTIC TANK TYPE/MFG I L CAPACITY 1!-ugal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG T CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL--L'5 L./r ft FOUNDATION I U ft PROPERTY LINE C:—:�T ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) !EACH LINES LEACHING CHAMBERS 11 G i(Q (S #OF LINES_3 LENGTH OF LINES ('03, ft DISTANCE TO NEAREST WELL 1J(ri ft FOUNDATION (✓t ft PROPERTY LINE t It ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ?ft FOUNDATION ft PROPERTY LINE ft i3 SEEPAGE PITS NUMBER J WIDTH _7V��) ft DEPTH_ �� ) It DISTANCE TO NEAREST WELL ft FOUNDATION (Cr ft PROPERTY LINET {t 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. MIWARLM49 ti R ADVANCET ED FOR INSPECTLONS y- EA LL09)953-762 3-7 7 SIGNED l 1 --� TITLE 2 i1''S''(,, 74, ly DATE --------------------------- T # R q YMF EcF�V�T SEP 1,1044020\j 2744 ------ 020 RO USN C ------------ Ty0 pgRTM��Y DEPART 'mu 'IccynuLy , 'h Application Accepted Bim' -L — Dat, /��y rL'�uu7 Area -1�/ q'"/7 Employee ID# UA Final Inspection By_T C---A—� Date 1 ;'2•trj 1: SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft; Pit/Sump Soil Character: COMMENTS�P,W S FI?. `` �er 7 :RooST)S:QA 1 a PE SC Received Check#10unt PertniU Code INFO Cas Remitted I Date Servic Re ueat# Invoice# Permit ID# LIAIT1 yG, 41 4/8 39zs3� 01 4„4„ ONSITE WASTEWATER TRTMNT SYSTEM PERMIT ��-�//�