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lbp'► ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)46SJ420 ' <br /> NON-REFUNDAB CALL 12119)953-7697 FOR INACTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> 309 ADDRESS CI alf, <br /> V / k I Z PN PARCEL Stze > <br /> CROSS STREET C <br /> 1 <br /> OWNER NAME Y PH <br /> OWNER ADDRF-% O.A. <br /> dye', C� CITY/STATEIZIP _ <br /> CONTRACTOR/ A' � L �{ '+ '/���/ -5 PHONE <br /> CONTRACTOR ADDRESS ! I`^'Wil.'� CITY/STATEIZIP 3ma �—j� <br /> LICENSE w C-42 Q C-36 OTHER_ NUMBER I EXPIRATION DATE ti 107 <br /> WATERTABLE DEPTH:_ f1 GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> I — PERC TEST #�T BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: P NEW INSTALLATION Q REPAIRIAODMON ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE O COMMERCIA4,a O OTHER <br /> NUMBEROFLIVTNGUNITS:� NUMBER OF BEDROOMS: 2ft NUMBER OF EMPLOYEES: <br /> SEPTICTANK TYPEfMFG CAPACITY O SPI #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 LIFTSTAT70N SIZE TYPE OF PUMP (3 PKC TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) I .� <br /> LEACH LINES X LEACHING CHAMBERS l #OF LINES LENGTH OF LINES l _ <br /> DiSTANC$TO NEAREST WELL 'F- ft FOUNDATION, ff PROPERTY LINE ft O <br /> ❑ FILTERBED Wiwni ft LENGTH ft DEPTH _ft <br /> DISTANCE TO NEAREST WELL_ ft FOUNDATION_ fl PROPERTY LIVE �- ft <br /> ❑ MOUNDED WIDTR ft LENGTH ft DEPTH _ ft <br /> DISTANCE TO NEAREST n WELL ft FOLNDAT.ION ft PROPERTY LINE ft v J <br /> SUMPS )C.3 WIDTH 2 ft LENGTH f A ft DEPTH ft <br /> DISTANCE TO NEAREST WELL 152H ft FOUNDATION R PROPERTY LNE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH_ ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOLNJATION ft PROPERTY LINE ft ^ <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH ft J <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIVE ft <br /> I HEREBY CERTIFY THAT T HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUhTt' <br /> RDINANCFS,STATE LAWS AND ROLES AND REGULATIONS OF SAN JOAQUIN COLT-TY. <br /> CEREQUIREDFO}i 'S� -S-P L(209)953-7697 rt!�` <br /> SIGNS ✓JI <J✓ TIT[ DATE V <br /> �\ A <br /> a P <br /> `{ .i AYME <br /> N OCT 3 2 <br /> EN --y�l) <br /> TH D PRfi <br /> nLir Ali <br /> i ✓ '�,� 'f-� ter ..— <br /> w 25- `'•� � 2IcIZvr's ' <br /> IDEPARTMENT US0IyLV <br /> Application Accepted Date e3 Area Employee ID# e Q <br /> Final Inspectionl/y Date ` L7 SPECIAL PERMIT-Approved by / <br /> Character of Soil to De of 3 Ft: PU/Sump Soil Character: <br /> COMNMNTs <br /> Po e- <br /> PE Sc Received rhec Amount Permit/ <br /> Code INPO B Cash Remitted Date Service nest# invoicell! Permit IDM <br /> 17 N6- <br /> 22/,3, aro <br /> 42-01 ��la/`/ 5. �Y/l�/' ONSITF WACTF.WATFR PERMIT <br />