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727�awk �c.an -1-3`6-t7 N` 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 JOB ADDRESS i 1( .S� �- T!yw fra i _ _ CITY/ZIP ^,,�'1<y1 iF e4. ,4 If 4►V y/ !,572!5 U CROSS STREET fU _ APN_ e�C�-1 �(r�j' PARCEL SIZE 3 ' -7 0 T� A OWNER NAME_ ( . J-� C yL L 4- rl . J OWNER ADDRESS L D ��' ✓ ��T'� �1_1 CITY/STATE/ZIP CONTRACTOR � C1 �� <!wX S4?-4PHONE CONTRACTOR ADDRESS AN Lo�l1 r CITY/STATE/ZIP i'Y 1-411eL✓+. C.'� �.7✓-�� LICENSE Ll C-42 ❑I C-36 OTHER NUMBER`�'� EXPIRATION DATE 1 WATER TABLE DEPTH:'��f -30 ft GEOGRAPHICAL INFORMATION: Coordinates X Y l 1 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# T-- _ TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: L10011iSIDENCE F1 COMMERCIAL L OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 4 4 NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ 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 ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) I___._._......___.._ .- ....... - -----------...._...___ _.___. 01 LEACH LINES I_I LEACHING CHAMBERS _ #OF LINES LENGTH OF LINES L�dl ft DISTANCE TO NEAREST WELL ft FOUNDATION 10 t ft PROPERTY LINE 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 t WIDTH �ft ST –1 r� N QT ft DEPTH ft ! ETRL)FOUNDATION ft PROPERTY LINE ft FJ ❑ DISPOSAL PONS EN " ft DEPTH ft 74A14'1�fl�V �e eXpi�$��tft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS 11�NI' 'il Qr IG�m��r� n or i� ft DEPTH ft "t2-70 LiA1StT' L FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I k I Iii le'N ari TF( Yv RK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 24 HOU ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE_.(,= �1_tl Gx� 1'a,' DATE I JA 01i oc 1 mFz W7 14r ARTMENT USE ONLY r Application Accepted By, c EPDate Area �—�-- Employee 1D# Final Inspection By Date __ CI SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE Sc Received Check#/ Amount Permit/Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# ala 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/24/12