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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 1 T/[ JOB ADDRESS 5-6 LatU �y- �RG� Ut CITY/ZIP e,�a"Lk-f VAJ CROSS STREET �Oy�ll 0,5;1I(S APN OFgDeoo3 PARCEL SIZE �`�• S` Y 0 OWNERNAME S-510S AdOIPrS Q �k'Q 00Ik CI`05� Inc- PHONE b b N OWNER ADDRESS )3�1 �JC�G1Yr� P�� CITY/STATE/ZIP ��LYC!✓�e �y �So�O CONTRACTOR 1�� 5 g'-wiQ� PHONE CONTRACTOR ADDRESS G to, ` CITY/STATE/ZIP LICENSE 11CIC-42 ❑IIC-36 OTHER /y — NUMBER 1 Zc7 EXPIRATION DATE f! - Z WATER TABLE DEPTH: I ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# - LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION I REPAIR/ADDITION 11 ENGINEER DESIGNED/ALTERNATIVE 11 REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM fJ DESTRUCTION INSTALLATION WILL SERVE: �3; RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBEROFBEDROOMS: 7 NUMBER OF EMPLOYEES: SEPTIC TANKX a TYPE/MFG f 5 CAPACITY z- gal #OF COMPARTMENTS Z ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL 15-0 f ft FOUNDATION Zn ft PROPERTY LINE S ft ❑ LIFT S T ATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES F-1 LEACHING CHAMBERS #OF I-INES 7 LENGTH OF LINES 7-5 957ft DISTANCE TO NEAREST WELL Iy ft FOUNDATION I U ft PROPERTY LINE GI V+/�� + ft ❑ 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 ft 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 } SEEPAGE PITS NUMBER WIDTH 3 6; ft DEPTH Z S_ f ft \ DISTANCE TO NEAREST WELL 4 ft FOUNDATION I C>� 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 SIGNED TITLE V DATE S I a—ZOZa 'i J ,q _ Fq11CU Pq T C D Application Accepted By �— Uate I��EPARTMENT USE ONLYdJd Area 9/ Employee ID# Final Inspection By Date ' _ ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit Surnp Soil Character: COMMENTS ]- � are cow-&-w w&& 0V-- 'k% Gni -Iro 44 tUtSzW ` L -�� 4� .�[sely► i'�S �-o M 1-5 PE SC Received Check#/ Amount Permit/ Code INFO By Cash Remitted Date— ervice Request# Invoice# Permit ID# d 117 �/1`j Shy I - ISKOUS) g 42-01 �Kg i /� ONSITEWASTEWATER TRTMNT SYSTEM PERMIT 4/14718 ��' _ -D gq_ )