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M <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 .(209) 468-3420 <br />NON-t(EFUNDA^BLE PERMIT I:ALL (LI#yJ yOJ-/Dy/ FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE <br />JOBADDRESS /-I-71� 6teby" GT CIT9YIZIP_ L_wp I -y/ Y) 52.3 Lv <br />CROSS STREET ` APIN � / PARCEL SIZE L- <br />OWNERNAME �+y�VlIQ VS(Z P'"✓YI O/1 T -&--s PHONE / <br />OWNER ADDRESS 3c',3 � 61 A(I YIJET L 11% CITYISTATEMP L-0077 / q 5-2 q <br />CONTRACTORJSLo.1JSTiZ LCt.TL27J ePTr2,. >r hiL PHONE ITIi� ( ,,e <br />z �- L{II-E 3 <br />CONTRACTOR ADDRESS OS �7 iTJO.0 P...i3�..) L,'J=� �' <br />CK P'7-0 CITYISTATE2J1P kz/L✓fD l4/q� <br />Z� <br />LICENSE VC-42L/C-36 OTHER NUMBER 9249 (p EXPIRATION DATE C ("/-?.7 / Z O Z_ <br />WATER TABLE DEPTH: <br />PERC TEST # <br />fl GEOGRAPHICAL I <br />BUILDING PERMIT # <br />des X Y <br />LAND USE APPLICATION #_ <br />7 <br />TYPE OF WORK: <br />NEW INSTALLATION <br />REI-AIRIADDITION <br />ENGINEER DESIGNED IALTERNATNE <br />2S <br />REPLACEMENT <br />OUT-OFSERVICE SEPTIC SYSTEM <br />DESTRUCTION <br />INSTALLATION WILL <br />SERVE: RESIDENCE <br />COMMERCIAL <br />OTHER <br />NUMBER OF LIVING UNITS: ( <br />NUMBER OF BEDROOMS: 'I <br />NUMBER OF EMPLOYEES: <br />/ <br />�(SCLT <br />Z <br />iJ SEPTIC TANK <br />TYPEJMFG F�JL (On)L <br />tt1C CAPACITY <br />981 #OFCOMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />It FOUNDATION <br />DISTANCE TO NEAREST. WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ UFT STATION <br />SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />L7 LEACH LINES LEACHING CHAMBERS j,-61+'rr # OF LINES 3 LENGTH OF LINES -3,— -! D ft <br />I 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 />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />PE SC Received Check## <br />Code INFO Cas <br />DISTANCE TO NEAREST <br />WELL Sb <br />ft FOUNDATION <br />2S <br />ft PROPERTY LINE 20, ft <br />(3 FILTER BED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />R FOUNDATION <br />ft PROPERTY LINE R <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />It PROPERTY LINE R <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH _ ft <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />ft PROPERTY LINE R <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE R <br />SEEPAGE PITS <br />NUMBER 3 <br />WIDTH <br />q' 2 1 I <br />ft DEPTH z S ft <br />DISTANCE TO NEAREST <br />WELL -400' <br />It FOUNDATION <br />2S __.. <br />ft PROPERTY LINE 2b' ft <br />I 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 />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />PE SC Received Check## <br />Code INFO Cas <br />Amount to PermlU invoice# <br /># <br />Remltt d Servicrre, <br />PemdtID# <br />/RI mutest <br />}1J f ✓ <br />42-01 ,w � /��� S ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4)14118 /lam / / `{J <br />