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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 <br />I.RLL /LOBI `JJJ-r D`Jr FOK INSPECTIONS - CXPIRES 7 TEAR <br />JOB ADDRESS <br />CROSS STREET q� I%)11 C%�i / / A, 1 /' APN L? /1 D Z '7 PARCEL SIZE 16 V <br />OWNER NAME I /L,._,,�1 .p �/ /'1 JN V-yNl &) r,G or-' PHONE <br />OWNER ADDRESS -�4 \ T� p� CITYISTATE%ZIP <br />CONTRACTOR�� <br />_DA� �C- S PI l,� _IS�A'V PHON-1 <br />CONTRACTOR ADDRESS /,/IY �'�N✓� �'� V 1- CITYISTATEIZIP <br />LICENSE _''C-42 ❑'C-36 OTHER_ NUMBER)/S-Z'/'..%3 EXPIRATION DATE 2u/Z-L3 <br />WATER TABLE DEPTH: I O — It GEOGRAPHICAL INFORMATION: Coordinates X Y <br />L PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION C.I REPAIR/ADDITION , I ENGINEER DESIGNED/ALTERNATIVE <br />AV REPLACEMENT }Ank 3" Lg -1 OUT -OF -SERVICE SEPTIC SYSTEM -r DESTRUCTION !— ! re' fy3N� <br />INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL A OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />e SEPTIC TANK <br />TYPE/MFG i Lo vet E <br />CAPACITY / 2.7 J <br />gal #OF COMPARTMENTS <br />❑ GREASETRAP <br />TYPE/MFG <br />CAPACITY <br />gal #OFCOMPARTMENTS <br />it FOUNDATION <br />It PROPERTY LINE II <br />C2 FILTER BED <br />WIDTH l cJ <br />DISTANCE TO NEAREST: WELLz <br />It FOUNDATION 111(�P' <br />ft PROPERTY LINE it <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES it <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />It PROPERTY LINE II <br />C2 FILTER BED <br />WIDTH l cJ <br />it LENGTH <br />2 c,— - <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL -. ' <br />it FOUNDATION 2 <br />ft PROPERTY LINE It <br />❑ MOUNDED <br />WIDTH _ <br />It LENGTH <br />ft <br />DEPTH it <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />ft PROPERTY LINE it <br />❑ SUMPS <br />WIDTH <br />it LENGTH <br />ft <br />DEPTH it <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />it PROPERTY LINE It <br />❑ DISPOSAL PONDS <br />WIDTH <br />R LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />it PROPERTY LINEit <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft <br />DEPTH It <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE R <br />1-IEREBY 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 />SIGNED <br />TITLE DATE /;Z/2 L-�: 1 <br />Final Inspection By Ad Date Li 41L - J. ( ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of I Ft: I Crit/Sump Soil Character: <br />COMMENTS Npp tmIS 6e- Aed FoPxist-in4 sy44eW1 Stated io be (or pz,21 hcusF nor LW,,Ll- UYII <br />Fa15VS}em alnfol/)9 �G-(�c <" (�otxilDack dram �ro��Yle. `;�ie�r'br tLz' be <br />drivedriveyl over. <br />PE SC Received I Amount Date Perm1U Invoice # Permit ID# <br />Code INFO By Cash Remitted Service Request # <br />Lj)16 its - <br />42 -01 <br />(s <br />42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114118 <br />