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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEAL H DEPARTMENT 1868 E. HAZELTON AVENUE-STOCKTON CA 95205 -(209) 468.3420 <br />NON-REFUNUABLE PERMIT CALL (209) 953-7697FOR LVSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />CITY/ZIP YYU.1'VLk.�O y <br />APN OI 71 �J I �/ PARCEL SIZE <br />PHONE 20q • 43 • 0 o <br />OWNER ADDRESS l t Iti 4a Ct4bV A -e- <br />-J CITY/STATFI71P <br />Dn,IADTo WeSf2',({.oa/s/��f�.►&Ck/ h(ce Inc • PHONE Z4q <br />33q. 73/9-{� <br />CONTRACTOR ADDRESS 33 f1 I(�Vit YI�G (f o7 CITYiSTATErZJP <br />�70I , 6r' 015'2 40 <br />[� <br />LICENSE C-42 CC --36 OTHER A NUMBER 6 • 1� <br />EXPIRATION DATE <br />LD� <br />WATER TABLF DEPTH: "J _ I � J <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION , REPA1rJADDITWn <br />ENGINEER DESIGNED )ALTERNATIVE <br />REPLACEMENT OLIT-OF-SERVICE SEPTIC SYSTEM <br />DESTRUCTION <br />INSTALLATION WILL SERVE: 01, RESIDENCE COMMERCIAL <br />_ <br />_ OTHER <br />NUMBER OF LNING UMTS: _ NLIMRFR OF BEDROOMS' <br />NUN13ER OF EMPLOYEES <br />❑ SEPTICTANK TYPF/MFG CAPACITY <br />gal #CFCOMPARIMEN-S <br />❑ GREASETRAP TYPEJMFG CAPACITY _ <br />gal #CF COM'ARIKIEN-S <br />DISTANCE TO NEAREST: WELLIt FOUNDATION <br />ft PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />_/ .. .. - --------/--'—tLL.!�_.__ <br />2--___ <br />LEACH LINES LEACHING CHAMBERS P. +0V S # OF LINES <br />- <br />I FW TH OF LINES 7w ft <br />DISTANCE TO NEARFST WELL I tom{ it FOUNDATION lij it PROFEKI Y LINE S It <br />(31 FILTER BED WIDTH F. LCNOTH It <br />DEPTH ft <br />DISTANGETO NEARCOT WELL It FOVNUAIIUNI <br />k PROPERI'YLINE ft <br />❑ MOUNDED WIDTH F. LENGTH Il <br />DEPTH It <br />DISIANCL, TO NEAREST WELL ft FOUNDATION <br />ft PROPER—(LINE ft <br />❑ SUMPS WIDTH ft LENGTH it <br />DEPTH ft <br />DIS'ANCE TO NEAREST WELL ft FOUNDATION _ <br />ft PROPER -Y I INF it <br />❑ DISPOSAL PONDS WIDTH ft LENGTH it <br />CI=PTI1 k <br />/ DISTANCE TO NEAREST WELL ft FOUNCATION <br />[S' SEEPAGE PITS L 11 <br />k rT.OPCRT/ LINF it <br />I <br />NUMBER WmHO ft <br />DEPl1 2t h <br />DISTANCF TO NEAREST WELL ISI' 11 rOUNCATION I t•J (! PROPERTY LINE �7 <br />_.. ... _ _. ._._..... _ 0000... _...._. _... ......... .. _. _...___.,..��, _.._ ___ _ <br />I HEREBY CEKI WY T HAT I HAVE PREPARED THIS APPUCATION AND THE WCRK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES <br />STATE LAWS AND RULES AND REGULA I IJNS OF SAN JOAQUIN COUNTY. <br />-------1 <br />7 / DEPARTMENT USE NL <br />B�/ <br />Appliceliuu Accepted `— /�—,�__ Date /J ? i Area 1j ('1 CI Employee IDrt <br />Final Inspection By_ �},•„7C1 .-14+r2 Date //ell o z I SPECIAL PFRMIT•Approredby <br />Character of Soil to Depth of 3 Ft: PIUSump Soil CharaetP.r: <br />COMMENTS Ileo tc- L•Pe.(b'v 1Ir(-y avt, 11,11 �z, bt <br />raocurreu 4neCKir/ Amount PermiU <br />Code INFO pa Ca h Remifted _ Ile t Serviceft* Pst N Invoice # Permit ID# <br />I-IJIy rls / 1°i 3Jo I 11 111jCC"Ni il'r <br />3211, <br />4114f18 Q�,-}/1-�/ <br />SCJ/L ' •I / 0 / (Q <br />ONSITE WASTEWATER TRTMN- SYSTEM PERMIT <br />CE FNT <br />Et) <br />0? 2421 <br />QUIN CpU <br />DNMENTq NTy <br />EPgRTIOENT <br />