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a : ONSFE WASTEWATER TREATMENT SYSTEM PERMUT SAN JOAQUIN COUNTY ENVIRONMENTAL HEAI_TI-1 DEPARTMENT 1868 E.HAZELTON AVENUE••STOCKTON CA 95205-(209)468-3420 BION-REFUNDABLE PERMIT .^ CALL 209 953-7697 FOR INSPECTIONS EXP IR ES 1 YEAR FROM DATE ISSUED JOB ADDRESS 3 tC� ayt ay,-aQ O CITY/ZIP - S+ m-rc C�- H Dakwoad APN 1}3506033 I CROSS STREET PARCEL SIZE /� ty .c' s7 OWNER NAME E; 1(� re�/ 3 h.,1e h ` PHONE OWNER ADDRESS �7/�3�10 lWyleri�0 CITY/STATE/ZjIPPS+CA-ton 93tI� CONTRACTOR F/I I ( J 13`G t PHONE CONTRACTOR ADDRESS AOX' CITY/STATE/ZIP LICENSE ❑LIC-42 ❑IJC-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING rPyERMIT# LAND USE APPLICATION# TYPE OF WORK: C NEW INSTALLATION //� REPAIR/ADDITION 0 ENGINEER DESIGNED/ALTERNATIVE x REPLACEMENT Ie'ch CIeld FI OUT-OF-SERVICE SEPTIC SYSTEM 0 DESTRUCTION INSTALLATION WILL SERVE: J�tSIDENCE ❑ COMMERCIAL ❑ OTHER NUMBEP.OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: El SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS CSI GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft © LIFT STATION SIZE _TYPE OF PUMP ❑ PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) PI-ILEACH LINES ❑ LEACHING CHAMBERS #OF LINES _ LENGTH OF LINES 6 It ft DISTANCE TO NEAREST WELL_ ft FOUNDATION ( 0 I ft PROPERTY LINE 16 ft FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIIJE ft L7 MOUNDED WIDTH ft LENGTH_ ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE_ ft (a SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft L7 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NE,�AREST WELL ft FOUNDATION ft PROPERTY LINE ft t SEEPAGE PITS NUMBER 1 a WIDTH 3G ft DEPTH IS / ft DISTANCE TO NEAREST WELLTaC2f ft FOUNDATION ft PROPERTY LINE ft 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. MINIMUM 48 HQUI ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209) 953-7697 SIGNED TITLE �� — DATE u J J 1AIDL IN C aL My �1c J IM H A T c ►.' -- — Q'J/ _H' 'I Ty M )y ±' L± t > j -DF_PARTMENT U E ONLY t� q Application Accepted _� ! v Date-- �-10.7 0Area / �g Employee ID# L)A Final Inspection By Date 1 W149 w SPECIAL PERMIT-Approved by 1, Character of Soil to Depth of 3 t: Pit/Sump Soil C aracter: COMMENTS Fadere o sfn, qycJ Cross/ ro p/ l/neS, here is no room -/o r0egy c o yy&n I sel backs k��%n 3 S�8YV1 Oki E'Xh� m< 10ff' i W ^S Coo rv-c Ad v►,� oI C1t L h S 0--Is PE Sc Receivedheck# Amount Date Permit/ Invoice# Permit ID# Code INFO By as Remitted Service Request# w ja IS 'oZ f 3c (r 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114118