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s- P COMMERCIAL <br />NUMBER OF BEDROOMS: <br />71 OTHER <br />NUMBER OF EMPLOYEES: <br />INSTALLATION WILL SERVE: E RESIDENCE <br />NUMBER OF LIVING UNITS: <br />CAPACITY <br />CAPACITY <br />SEPTIC TANK <br />Li GREASE TRAP <br />LIFT STATION <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE OF PUMP <br /> gal # OF COMPARTMENTS <br /> gal # OF COMPARTMENTS <br /> ft PROPERTY LINE ft <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br /> ft FOUNDATION <br />PKG TX PLANT <br /> ft FOUNDATION ft PROPERTY LINE ft <br />2 <br />DATE TITLE <br />• <br />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) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 342-- Fest- P-0 et..01 <br />CROSS STREET -RA • <br />OWNER Name L4c1,i kl 3 Pc, y 61 3 PHONE <br />OWNER ADDRESS Sei ifIn€ CITY/STATE/ZIP <br />V\IP c+ pad' oc, <br />ordzip SitiCtOWI 16lt5 <br />APN d 0 IS- PARCEL SIZE 3_ F .? <br />CONTRACTOR PHONE 2 oci 33'3 • -139 14 <br />CITY/STATE/ZIP LOC& ej . çi D <br />LICENSE 'I C-42 LI C-36 OTHER NUMBER R51 I 5-7 EXPIRATION DATE 2.0 2-3 <br />CONTRACTOR ADDRESS 33 Ail a-txwe 11 . <br />WATER TABLE DEPTH: )00 --- JO ft GEOGRAPHICAL INFORMATION: Coordinates X <br />TYPE OF WORK: <br />LI PERC TEST # LAND USE APPLICATION # <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />BUILDING PERMIT # <br />NEW INSTALLATION REPAIR/ADDITION <br />REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM <br /># OF LINES LENGTH OF LINES 1 ft <br />DISTANCE TO NEAREST WELL b0 ft FOUNDATION <br />FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />A" LEACH LINES LEACHING CHAMBERS 111P1 Vile& Alltr crir ft PROPERTY LINE ft <br /> <br /> ft DEPTH ft <br />MOUNDED WIDTH ft LENGTH <br /> <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />DISPOSAL PONDS Mom ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />gir SEEPAGE PITS NUMBER WIDTH :3(1, <br /> <br />ft PROPERTY LINE ft <br />ft DEPTH 2. 5 ft <br />ft DEPTH ft <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL IC) ft FOUNDATION 101,5" 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 /> <br />PERMIT -Approved by Final Inspection By <br />Date <br />Datey <br />ey <br />,2.o2-1 E. SPECIAL <br />Area 111qq Employee ID# S <br />DEPARTMENj U E ONLY <br />Application Accepted <br />Pit/Sump Soil character: <br />(e et 11,7 43, <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />Check#/ <br />Cash <br />Amount <br />Remitted pate Permit/ <br />Service R uest # Invoice # Permit ID# <br />9 1 4 1,5- til Vi ri"- Li 11 5 10 <br />12-32-ceqq- ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />SIGNED <br />Character of Soil to Dept <br />COMMENTS iI <br />‘i le4 <br />of 3 Ft: <br />e/V; 0-1 n :SSMIGGV 311'