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4 <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HLALTH DEPARTMENT 1868 E. HAZELTON AVENUE-STOCKTON CA 95205 -(209) 4683420 <br />_NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS <br />CROSSSTREET 1�6�(,,g r APN V j 7J-7,0 j Cl <br />N61 bri, �Y�1ALl �1 - PARCEL SIZE <br />OWNER NAME PHONE <br />OWNER ADDRESS Sif, 1-1'1 t' <br />nn''�� 4MSraTE/LP/ � �l ` .� A y� . I <br />CONTRACTOR �/i�'%,�j ��/� PHONE ! � / 1 �.� - (SAµ <br />CONTRACTOR ADDRESS 133 � • �X 95'11 <br />1111TAT UA) V r�JJI /(✓�j` 1C IA Ic1,5� f' b <br />LICENSE Cd2 C-36 OTHER I 1 NUMBER • I � EXPIRATIONDATF 21),2 7 T <br />WArER TABLF. DEPTH: Ilo- W fl GEOORAPHICgL INFORMATION; Coordinates X Y— <br />L <br />PERC TEST I_ BUILDING PERMIT # ' << r17Y LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED ,ALTERNATIVE <br />REPLACEMENT DUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: -1. RESIDENCE _: COMNERCIAI - OTHER <br />NUMBER OF LIVRRG UNITS: N4umcv ,.� oma ............. .... _ <br />❑ GREASETRAP <br />❑ LIF -i' STATION <br />.. —.... - iR -- -11I r ! W % V gal A OF UOMPARTMENTS X_-- _ <br />TYPEJh7FG t�h CA'ACITY qai #OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL 'IXJ it FoJNDATION ID h PROPERTY LINE 1_ ft <br />SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR (ENOLUSED SYSTEM) <br />9 LEACH LINES <br />LEACHING CHAMBERS T T(� IUYS # OF LINES _L�_ LENGTH OF I.INEs l!/ IGI it <br />El FILTER BFD <br />DISTANCE TO NEAREST WELL ft FOJNDATION_�_ it PROPERTY LINE 5 ft <br />WIDTH It LCNGTH 't DEPTH ft <br />DISTANCETONEAREST YYELL it FOUNUAILIN tl PROPERTY LINE ft <br />❑ MOUNDED WIDTH R LENGTH fl DEPTH ft <br />DISI ANCE TO NEAREST WELL it FOJNDAT ON ft PROPERTY LINE ft <br />❑ SUMPS WIDTH ft LENGTH it DEPTM ft <br />DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br />❑ DISPOSALPONDS WIDTH f LENGTH k TIEPTFI ft <br />DISTANCE TO N ST 4YEUL ft FOUNDATION R PROPER,' LINE ft <br />V/ SEEPAGE PITS NUMBER ___ Wr.TH � II it CCPT11 ? ft <br />DISTANCE TO NFARFST WELL ` II FOUNDATION ft PROPERTY UNL ft <br />I HEREBY CERTIFY I MAI <br />1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. <br />STAT'[ LAWS' AND RULES AND REGULATIONS Oh SAN JOAQUIN COUNTY. <br />DEPARAMENi SE AILY <br />Application Accepted By �`_Date Area i �) <br />< 0� Employee ID# F, ` <br />Final Inspection By Date _ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: PIVSump Sol I Character: <br />COMMENTS �(. !+l c, L./. tlt c• G^t�Tf'•- /; 7ir'' _ <br />PE SC Received ChedcA/ Amount Permit/ <br />Code INFO Ca Remitted Date Service R uest # Invoice # Permit IDN <br />;/s a12 s�z <br />42-01 ONSITE WASTEWATER TRTIANT SYSTEM PERMIT <br />3;14.118k <br />yr <br />0 <br />