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`k' -r ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT / y� �p� CALL 209 953-7697 FOR INSPECTIONS EXPIRES 'InYEAR FROM DATE ISSUED JOB ADDRESS /D ` d3ZEDE/✓IA,�J l�y CITY/ZIP Od S -CROSS STREET �AP�N o./PARCEL SIZE OWNER NAM o- 26's U-1 PHON/��)3�z 9 H8 r OWNER ADDRESSS—(,& 7 D -K^^T/rt lqV-(-- CITY/STATE/ZIP �1�V � � V� /� - li/ 9,57— CONTRACTOR\T/F 1' PHONE CONTRACTOR ADDRESS LICENSE 1111C-42 11oC-36 OTHER CITY/STATE/ZIP NUMBER EXPIRATION DATE WATER TABLE DEPTH: I (� 1 1 v ft GEOGRAPHICAL INFORMATION: Coordinates X t/� V ` Y JI`�� ' O� �� ' V ❑ PERC TEST # BUILDING PERMIT # P,�-D LAND USE APPLICATION # TYPE OF WORK: 7Y NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM CI DESTRUCTION INSTALLATION WILL SERVE: M'RESIDENCE ❑ COMMERCIALElOTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 2 NUMBER OF EMPLOYEES: 91"SEPTICTANK TYPE/MFG I r ` J � F-rj ` V r` Z P 0) Y CAPACITY /�� gal # OF COMPARTMENTS 3 ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS ft LENGTH ft DEPTH ft /60 2 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISTANCE TO NEAREST: WELL ft FOUNDATION J ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ll Application Accepted By �- Final Inspection By Character of Soil to Depth of 3 Ft: CQMMENTS NetiJ SFR L Date Area -l/%/ Empl Date ❑ SPECIAL PERMIT-Appr Pit/Sump Soil Character: n! /4.1/6;10 f A1- n 1, CA 416 1 a `k, ,.� Hi ::,o 14,1 k S PE SC Received LEACH LINES ❑ LEACHING CHAMBERS # OF LINES ✓ LENGTH OF LINES 7/b� ft Code INFO B Cash Remitted Service Request # DISTANCE TO NEAREST WELL �� ft FOUNDATION l ' ft PROPERTY LINE 4 v 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 WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ftft PROPERTY LINE ft SEEPAGE PITS NUMBER J (F''OUNDATION x WIDTH ✓ `•� ft DEPTH ft DISTANCE TO NEAREST p ! WELL ft FOUNDATION 0 ft PROPERTY LINE ft 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. MINI 48UR ADV E NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-76 7 SIGNED _ TITLE e W .'UC�sC� DATE �711 ll Application Accepted By �- Final Inspection By Character of Soil to Depth of 3 Ft: CQMMENTS NetiJ SFR L Date Area -l/%/ Empl Date ❑ SPECIAL PERMIT-Appr Pit/Sump Soil Character: n! /4.1/6;10 f A1- n 1, CA 416 1 a `k, ,.� Hi ::,o 14,1 k S PE SC Received Check#/ ount Date Permit/ Invoice # Code INFO B Cash Remitted Service Request # H 7 sg 1 ► W2 50 l Co�� r K� at I S 0 ovrl zr- 0 , Vnl 4!� -1 r� v w Lug � i; .. .-LI % - . %-- / 42-01 ' J y� J V11 �% 'J.�.9� t —> -� kertkG�L•9yl f kl-L,.L. �1�i�lre'•l_�—q 'T►11 VJA- ( rAZOP � . i' t �cl S� LL ��t . • �� l 2l ` �2 i5A0Mere ��t0 so�i(over �%2