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I ,= ONSITE WASTEWATER TREATMENT SYSTEM PERMIT iSAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202.(209)468-3420 NON-REWNDABLE PERMIT CALL 209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DTE ISSUED JOB ADDRESS p s t-/,[�/� �� CITY/ZIP LG 1AUc14L-�1 16-A"3 L CROSSSTREET GO na�g�n/�s' -__ APN f J3-3 20 m PARCELSI7.E 1O/QCQj S --I'7 0 0 OWNER NAME PHONE rA OIvtiER ADDRESS CITY/STATF/ZIP L/adz, (_4 7L�_ i CONTRACTOR PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP I� LICENSE ❑ C42 ❑ C-36 OTHER NUMBER F.xPIR-anoN DATE i WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# -07035110 LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE 13COMMERCIAL OTHER SfFC>O��E.S-T�17b� i NU%fBER OF LIVING UNITS: e nN UMBER OF BEDROOMS: NL%IBEROFEMPLOYEES: SEPTICTANK TYPE/MFG T(,J CAPACITY 1_2_� gal #OF COMPARTMENTS 7 1 ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL I OU 'f ft FOLNDATION ft PROPERTY LINE R ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG Tx PLA�rr ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) q1 LEACH LINES ❑ LEACHING CHAMBERS #OF LUES LENGTH OF LINES �TZ,J It DISTANCE TO NEAREST WELL /OU+ ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE.TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE R ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 'T1 ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIVE ft (3 DISPOSAL PONDS W'mrH ft LENGTH ft DEPTH ft DISTANCE TO NEA,R/QST WELL Il FOUNDATION ft PROPERTY LINE R q ! q� SEEPAGE PITS NUMBER T WIDTH .3 ft - DEPTH o2S ft DISTANCE.TO NEAREST WELL 15%) "("' ft FOUNDATION ft PROPERTY LINE ft 1 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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPEC`TIIONS-PLEASE CALL(209)953-7697 SIGNED TITLE VQi,(,9& DATE !G -6-0? -77 HIM . 1111 11111 11111 11111 Orr " II N IR NN E HR7 EP DEPARTMENT t7,E ONLY Tal Application Acce4toep Date O c[3 4WO-7 Area Employee IN737 g Final Inspection _ Date ! I ❑ SPECIAL.PERMIT-Approved by - Character of Soilof 3 FFt: Pi ump Soil Character. COMMENTS 0�-'J CLuT 0-r /QC- S�fS-F-et-I WILL- SE4VE F- t7uro-E 3 &)2 ISS C tl S PE SC Received Check.*/ Amount Permit/ Code INFO By a Remitted Date Service Request# Invoice# - Permit ID# 3 O -S,goo SIR 14 51 42-01 ONSITE WASTEWATER PERMIT 05/30:2007