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/Ak. /-36 11VW 5001 IV WO <br />ell? z: ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAOLIIN 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 />NEW INSTALLATION 4,01-+ REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM , DESTRUCTION <br />JOB ADDRESS _iryo <br />CROSS STREET .r.fittan,Q <br />OWNER Naha <br />OWNER ADDRESS <br />S+ CITY/ZIP /carejaps) <br />APN 14:1 PARCEL SIZE <br />CiVrgd'q 4916(A/W PHONE CO <br />CITY/STATE/ZIP <br />Ill <br />CONTRACTOR PHONE 342,, 52) Z2 <br />CONTRACTOR ADDRESS olge,‘._ If2,40n.L. pie CITY/STATE/ZIP <br />LICENSE (k,-42 C-36 OTHER NUMBER 212±,.5- EXPIRATION DATE 04/./3//b2._ <br />te‘ <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: <br />WATER TABLE DEPTH: <br />Li PERC TEST If <br />SEPTIC TANK TYPE/MFG .6A6;u5 <br />GREASE TRAP TYPE/MFG CAPACITY <br />gal # OF COMPARTMENTS 401 <br /> gal # Of COMPARTMENTS <br />CAPACITY izAe4D <br />P <br />Application Accepte Date <br />Final Inspection By Date & <br />Character of Soil to pth of 3 Ft_ Pit/Sump Soil Character: <br />COMMENTS ?VOL-4£7i .4e0 <br />Area 41.1 <br />RM1T • Approved by <br />Employee if:/# <br />Ll SPECIAL <br /> eteeer° '10 <br />it2A1 Ls71 <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check*! <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request * Invoice * Permit ID* <br />if 0 g‘ ..elo...*** - 7 " '.1„, d a 0 -itela <br />ONSITE WASTEWATER TFITMNT SYSTEM PERMIT <br />L11'-' <br />Mt <br />LI <br />'444- <br />'ed41- <br />-...CrneXA-bAj <br />TMENT E 0 <br />42-01 <br />4124112 <br /> <br />INSTALLATION WILL SERVE: RESIDENCE <br /> 0 COMMERCIAL <br /> <br />NUMBER OF LAVING UNITS: ) NUMBER OF BEDROOMS: <br />0 OTHER <br />NUMBER OF EMPLOYEES: <br />DISTANCE TO NEAREST: WELL It FOUNDATION It PROPERTY LINE _ ft <br />LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />IA-TEACHING CHAMBERS <br /> # OF LINES Ars- LENGTH OF LINES 40 YO " ft <br />DISTANCE TO NEAREST WELL hICAAPE. ft FOUNDATION )0' ft PROPERTY LINE 5 . It <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br /> <br />ft FOUNDATION ft PFIOPERTY LINE . ft <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />DISPOSAL PONDS WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION _ft PROPERTY LINE_____ _ _ ft <br />SEEPAGE PITS NUMBER <br />WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL _ ft FOUNDATION ft PROPERTY LINE ft <br />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 />MINIJrZPM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED <br /> TITLE_4101/61,1derc. DATE <br />cit. LEACH LINES <br />LJ FILTER BED <br />MOUNDED <br />SUMPS