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�) OD ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)466-3420 NON-REFUNDABLE PERMIT CALL 2p9 95J-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATEISSUED JOB ADDRESS' 1.. --- - CIN/ZIP U-�►7L`f� 61S?--3(6 CROSS STREET c1/U..t�-1 �� X17 APN CxO�J �00 — t PARCEL SIZE 939.4,11 �� 5 b OWNER NAME WQt✓JTP ry �'1 YaMS�l PHONE OWNER ADDRESS C ,�p�Q� C�� CITY/STATE/ZIP G1 2 q C CONTRACTOR J�"'nom`` c /r�G-+ `L IV 1C- AvePHONE L J�L ZS Jz- 14 r CONTRACTOR ADDRESS GV -L'�'�'`A "' � o��pp CITY/STATE/ZIP L oD t CA q5Z�C.O LICENSE I�r42 C]C-36 OTHER NUMBER ZS�J�y EXPIRATION DATE Vy�LO,I 3 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y U PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# L-. - --------W-kg- -- TYPE OF WORK: YL NEW INSTALLATION LI REPAIRIADDITION 1. ENGINEER DESIGNED/ALTERNATIVE .. REPLACEMENT :I OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: 1 RESIDENCE L I COMMERCIAL/1 t�Q OTHER NUMBER OF LIVING UNITS: //__ I NUMBER OF BEDROOMS: / NUMBER OF EMPLOYEES: SEPTIC TANK TYPEIMFG 7T L' CAPACITY 1+�0� gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL '~ ft FOUNDATION 40 f- ft PROPERTY LINE ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) f U LEACH LINES III.- LEACHING CHAMBERS #OF LINES -7 Z 0 LENGTH OF LINES (.0ft 75 DISTANCE To NEAREST WELL 50't ft FOUNDATION '* ft PROPERTY LINE is o f 4 ft ❑ FILTER BED WIDTH ft LENGTH It DEPTH it DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE ft tir- SEEPAGE PITS NUMBER Z WIDTH t--I 1B t It DEPTH ZS r it DISTANCE TO NEAREST WELL 100 t ft FOUNDATION g� } it PROPERTY LINE I 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. MINL&JU924 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE Ci-'"�TYtiP'-C.sTp--�- DATE 171/ U yy; q - 11 _ r DEPARTMENT SE LY Application Acc];D Date Area r Employee ID# ��jCbh Final Inspectionftt, �' Date::3=/� ❑ SPECIAL PER/MIT-Approved by Character of SoiP Sump Soil Character: COMMENTS Z-, — 04 PE SC Received CheckX Amount PermiU Date Invoice# Permit IDN Code INFO 8 ash Remitted Service Request# I —j-..----------d 42-01 ON$ITE WASTEWATER TRTMNT SYSTEM PERMIT or2trlo