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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />y SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1566 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 466-3420 <br />NoN-REFUNDABLE PERMIT _ CALL (209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />Jos ADDRESS _ .�� v(',(�}�i-.j ._. L./� CITYJZIP7f- <br />CROSS <br />f- <br />CR�REET "w — _ LlSi �,. �>'% , APN �... (.Z `� - 313 / Ci , PARCEL SIZE <br />OWNERNAME �PHONE._L„C�__ <br />OWNER ADDRESS r e CtTY1STATFJZIP <br />CONTRACTOR _....._...._4_.i.,�% /-1i, y .J,',.-£ !-.Ve- PHONE <br />CONTRACTOR ADDRESS! V i I/I �� .�.�.(t��J. CITYISTAT£/ZIP <br />LICENSE..`C-42 °:C-36 OTHER NUMBER EXPIRATION EXPIRATION DATE'—��''''%�'`/� <br />WATER TABLE DEPTH: <br />U, PERC TEST # <br />TYPE OF WORK: <br />ft GEOGRAPHICAL INFORMATION: COOrdin2te5 X Y <br />—� j BUILDING PERMIT # LAND USE APPLICATION # <br />NEW INSTALLATION I RrPA1RIADDITiON ENGINEER DESIGNED IALTERNATIVE <br />REPLACEMENT .., OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: <br />f✓ R£S10ENCE I. COMMERCIAL OTHER <br />NUMBER OF LIVING <br />UNITS: _ NUMBER OF BEDROOMS:. NUMBER OF EMPLOYEES: <br />U SEPTIC TANK <br />fYPEiMFU CAPACITY gel # OF COMPARTMEN'f5 <br />LI GREASE TRAP <br />TYPEIMFG _— CAPACnv gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION IT PROPEP.TY LINE ft <br />O LIFT STATION <br />SIZE TYPE OF PUMP Ct PKG TX PLANT L1 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />LEACHING CHAMBERS # OF LINES v LENGTH OF LINES _& It <br />/� <br />DISTANCE TO NEAREST WELL {J�I it FOUNMA ION ft PROPERTY LiNLC <br />��.;1�` <br />WIDTH ._.._ '� ft LENGTH_ __ft DEPTH <br />DISTANCE TO NEAREST WELL l�"� f? FOUNDATION +jtj2�-- R PROPERTY LINE <br />LI MOUNDED <br />WIDTH v ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST 'NELL ft FOUNDATION ft PROPERTY LINE ft <br />LI SUMPS <br />WIDTH _ ft LENGTH It DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE: It <br />L1 DISPOSAL PONDS WIDTH _ _,._.._ ft LENGTH ft DEPTH ft <br />DiSTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY LINE,,,,,,,_„ ft <br />LI SEEPAGEPITS <br />NUMBER WIDTH "_ft DEPTH _._ it <br />DISTANCE TO NEAREST WELL ft FOUNOATION ft PROPERTY LINE_„_,. ft <br />I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />PE $C <br />Code (NPO <br />Received Chea Amount <br />S _ i'— emittod <br />Date Permltt <br />; Service Rs nest # <br />Invoice #' <br />Permit ID# —� <br />_ <br />42-01 ONSITE WASTEWATER TR WNT SYS"fEM PERMIT <br />41141i8 <br />