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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT a CALL 209 953-7697 FOR INSPECT70NS EXPIRES I YEAR FROM DATE ISSUED JoB ADDRESS 1 5-00 qz Lt3l,Y\t✓&_4_- r'-0 x .__._....._......_..._.......___.......CITYMP CROSS STREET 'Jr'v /� ------ ---.._...... APN....� :! 1L„tY..-- --PARCEL SIZE o OWNER NAME M//94 ,lw ' PHO,)N7E�? /3;b7-j163�'- OWNER ADDRESS Y L-HFJ��G,.�C �yJL,r,C��.�.._�_Vu ITYY/STATE21 P —, 01/i._fvA �7�'"(J Z- CONTRACTOR 1.-Prr 601OUT..._ y w="_..._._---------—__......._—. . . .. � j _. .PHONE— CONTRACTOR ADDRESS �3 —_....._........._CITYISTATEZZP t )(C-42 C � 3b OTHER NUMBER DATE. LICENSE — -T� 0 S WATER TABLE DEPTH: _.____it GEOGRAPHICAL INFORMATION: COordinateS X ____.. Y ❑ PERC TEST r BUILDING PERMIT#_„__....._......._.._........._..—LAND USE APPLICATION# n TYPE OF WORK: NEW INSTALLATION - REPAIRIAODMON ENGINFJcR DESIGNED/ALTERNATIVE REPLACEMENT _ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: E RESIDENCE COMMERCIAL LI OTHER NUMBER OF LIVING UNITS' ,f NUMBER OF BEDROOMS: '7 —,. NUMBER OF EMPLOYEES: SEPTIC TANK TYPEIMFG ._......� �!,.r —_.._...._.... CAPACITY-„ .._.__ gal #OF COMPARTMENTS ❑ GREASE TRAP TYPEIMFG _.__...__ CAPACITY _._ gal #OF COMPARTMENTS 1 DISTANCE TO NEAREST: WELL It FOUNDATION _, It PROPERTY LINE ft LIFT STATION SIZE TYPE OF PUMP_Vjj.ff__...❑ PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) ------ —.__..._._......_._.._....... ......__._..... -'-----._._......_.. ---------------- — ❑ LEACH LINES LEACHING CHAMBERS ___......_. #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft FILTER BED WIDTH. Q.--ft LENGTY__............_._L��...__.--- rr11 ft DEPTH 9llSP%A�_it DISTANCE TO NEAREST WELLtDQL....._.It FOUNOA110N ![.__ .—ft PROPERTY LINE S ft ❑ MOUNDED WIDTH _._ft LENGTH-........._..,,_.._..._......__........_..... DEPTH, ft DISTANCE TO NEAREST WELL _........,,,,ft FOUNDA PION .It PROPERTY LINE .It `� Y ❑ SUMPS WIDTH...--- __'--ft LENGTH_..._...-.... .... ftECEIVE1A_ft ....................._.._...._........._..__.._.,h DEPTH DISTANCE To NEAREST WELL ., It FOUNDA rION _—ft PROPERTY LINE It -e ❑ DISPOSALPONDS WIDTH it LENGTH,_......._._....-._.__._.._._....._..._ ft DEPTH iif'T � l 9817 tt �V DISTANCE TO NEAREST WELL__,,,_,,,_..._...... It FOUNDATION __._._II PROPERTY NE.� ft a Cl SEEPAGE PITS NUMBER__,__...-..._. ..—_ WIDTH—___,.,,,,.._ _ _..._._ft DEPTH._ JOA4UINCOUNTY ft P DISTANCE TO NEAREST WELL _ ft FOUNOATIoN — ft PROPERTY AR{;H9 ft 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITHORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION WS. MINIMUM 24 HD ADVA E NOTICE ED FOR INSPECTIONS-PLEASE CALL 209 953-7 97 , SIGNED _....... TITLE....._.,,~..._1T _....__ _ DATE h IIr RJA4_._1 it . ..._......RT T U N Application Acceptetl Data kQ i. .. _......._ AreaEmployes ID# �� rl D SPECIAL PERMIT-Approved by Final Inspeetlon ByDateCharacterofSoilto epthof3Ft: PittSump Soil Character: COMMENTSL?�-yll�- ;7/✓ Inks 11647- 1 111 >Al �rob.uirve� C'0► .S Qrn _. rte_ S't �_ f ITf` ) PE SC Received Check Amount Dr a Permit/ invoice# Permit ID# Code INFO UAs Ra Itted Service Request# 71-3 s.. . 42-01 ONS11 E WASTEWATER TRTMNT SYSTEM PERMIT 515117