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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 (209)953-71697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS /611/6' Esredoc7gr7/e-4-, CITY/ZIP <br />PHONE <br />CROSS STREET &hay APN 2_1c1 0g0 2.5 PARCEL SIZE <br />OWNER NAME Jc,i1111 /ler <br />OWNER ADDRESS <br />CONTRACTOR /4/921— ACkiC.XC <br />CONTRACTOR ADDRESS 0e 5' Uji <br />LICENSE Li C-42 0 _C-36 OTHER <br />Y . 6 <br />NUMBER 7/ 302 II EXPIRATION DATE <br />CITY/STATE/ZIP <br />Z.09 S77 - 779V <br />ciTyisTATElzip nodes-I- 0, <4- <br />PHONE <br />0'5 ft GEOGRAPHICAL INFORPIla.,TION: Coor_ jaaldin te X <br />BUILDING PERMIT # 2_10 .1ffl-MID USE APPLICATION # <br />WATER TABLE DEPTH: <br />LLi PERC TEST # <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br />REPAIR/ADDITION <br />_ OUT-OF-SERVICE SEPTIC SYSTEM <br />_ ENGINEER DESIGNED,2L_RNATIVE <br />DESTRUCTION GI/ /w2 ,& <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />A RESIDENCE E COMMERCIAL <br />NUMBER OF BEDROOMS: <br />0 OTHER <br /> <br />NUMBER OF EMPLOYEES: <br />Al. SEPTIC TANK TYPE/MFG 4:woe'?Pt CAPACITY I> L) gal # OF COMPARTMENTS <br /> <br />ID GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION ft PROPERTY LINE <br /> ft <br />LI LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />Xi LEACH LINES E LEACHING CHAMBERS # OF LINES 3 LI LENGTH OF LINES <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEA EST WELL ft FDLJNnAF1N ft PROPERTY LINE ft <br />4 SEEPAGE PITS NUMBER WIDTH 3 6 ft DEPTH <br />DISTANCE TO fEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <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 />SIGNED C • a TITLE /5:re 70,1 DATE //5 <br />MINI pM 48 HOU DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 :SS3HCII3V 311S k&ckQQ <br />SAN <br />(....1S'ARTMENT USE ON Y . <br />Application Accepted Date / z I Area <br />Final Inspection By <br />et Adair* <br />ir Date <br />) 5Z24 0 SPECIAL <br />Character of Soil to pp:0.°f 3 Ft: Pit/Jump Soil Character% <br />PE <br />Code <br />SC <br />INFO <br />Received Check#/ <br />Cash. <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />14' 2- \ \ I 1- j9- riitectri- 5 '-t 1. r).2.1 S a 00%3 IIDGI <br />q Employee ID# Da_ ri <br />ERMIT - Approved by <br />COEMENTS 3;f._ re-P 4C OA h 7 f// - 004erkieci <br />(3,1 n pq'r (.00 rril 1.1C r I if) a rirz <br />ota lines rola <br />42-01 <br />4/14118 e_j5W //93062-q ONSITE WASTEWATER TRTMNT SYSTEM PERMIT