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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL W91 953-7697 FOR INSPECTIONS ^ �I EXPIRES 1/7YEARR FROM DATE ISSUED <br /> JOB ADDRESS �.'y�� / 9 'Lf �0��`yam �c�- CITY(21P FI <br /> CROSS STREET l ✓� APN D f DJJ30, <br /> PARCEL SIZE <br /> OWNERNAME ,t�r��,a.GLIPJA/�yzpoj IP-O PHONE !' <br /> Y_/_ J�3 <br /> OWNER ADDRESS _>�YS //S ,'vim % / Cm/STATEMP/ CU.M120 --/5�;220_ <br /> CONTRACTOR e-,,/X✓1/�7,lI//rJ /7 C���� bP,HONEG�TJ�Z7� <br /> CONTRACTOR ADDRESS /7 C:� ( 1Lf -- 2;%"C J�1cbnY/STATE/ZIP /J LI <br /> LICENSE V�-42 ❑ C--36 OTHER NUMBER S S EXPIRATION DATE <br /> WATER TABL1 <br /> E DEPTH: /b0 It GEOGRAPHICAL INFORMATION: COOrdinates X Y <br /> _l PERC TEST # BUILDING PERMIT# OO LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-UF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: V-RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: .;2 NUMBER OF EMPLOYEES: <br /> 19, SEPTIC TANK TYPFJMFG 6d L CAPACITY ��GO <br /> gal #OF COMPARTMENTS Z <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL Zco It FOUNDATION 7' It PROPERTY LINE �2t, ft <br /> O LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES Z LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ZO R PROPERTY LINE 3Q ft <br /> ❑ FILTER BED WIDTH It LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH R LENGTH it DEPTH It <br /> DISTANCE TO NEAREST WELL it FOUNDATION It PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE <br /> SEEPAGE PITS NUMBER It <br /> A WIDTH ft DEPTH .?r� ft <br /> DISTANCE TO NEAREST WELL_It FOUNDATION 7CI' It PROPERTY UNE JO It <br /> I HEREBY 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 /> 48 HQUa ADV4 NO ME REQUIRED FOq INSI - LEA L 2 -7 7 <br /> SIGNED •--� TITLE DATE � Z/ <br /> �T <br /> 1A L <br /> �D <br /> ZO <br /> / DEPARTLY J ly1 TlR COU <br /> Application Accepted �� Date (� Area — Employee-)VTw.Nr' <br /> Final Inspection By Data �4 0 SPECIAL PERMti-Approved by —P-A <br /> Character of Soil to Depth of 3 Ft: If Pit/Sump Sol)Character: <br /> COMMENTS A)e / SFQ- Z"f-r meuyi it 100' t TaYT C rCTI�ti(� f t' qtr br <br /> Str�..`y$. �6��l�irin rom 10, n .f :��/5 PkS :yl �h (.�PPt�I. <br /> L G re- � oe" n °K <br /> PE SC Receiv Chec Amount Data Permit/ Invoice# PermitlD# <br /> Code INFO B ash Remitted Service Re uest# <br /> I f► 1LI M- L2 49 <br /> 42-01 (20 ,w'�I f` 1"L� 0 Or <br /> 4/14118TEWATER.141TRTMNT SYSTEM PERMIT <br />