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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE_ - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT ___CALL (209) 953-7697 FOR INSPECTIONS -_ EXPIRES I YEAR FROM DATE ISSUED <br />JOBADDRESS©� �0/Vl/KE2yp'L 47- CITY/ZIP4A7�gkoP f KUO <br />CROSS STREET_�. �2� ✓G - APNZ-✓! �_0� —PARCEL SIZE <br />OWNER NAME &4 eV /r-- -�r%/ t_ _�%is,Ll _ PHONE__ <br />OWNER ADDRESS �i •� CITY/STATE/ZIP <br />CONTRACTOR --/uLMtiC.__—_ PHONEff% <br />CONTRACTOR ADDRESS _ �a �y'/j��l�'7�G_ CITY/STATE/ZIP <br />LICENSE 111 -IC -42 L11 1C-36 OTHER NUMBER /03y�4ZExPIRATION DATE/ <br />',NATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION <br />LPERC TEST # --I BUILDING (PERMIT # PIR IQ <br />TYPE OF WORK: Ci NEW INSTALLATION ❑ f <br />I.l REPLACEMENT I mWrm <br />4 <br />INSTALLATION WILL SERVE: ❑ RESIDENCE A-�-4111kxM <br />(NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />SEPTIC TANK TYPE/MFG <br />G GREASE TRAP TYPE/MFG <br />Coordinates X <br />CAPACITY <br />CAPACITY <br />DISTANCE TO NEAREST: WELL ft FOUNDATION _ <br />0 LIFT STATION SIZE TYPE OF PUMP L PKG TC PLANT <br />D USE APPLICATION #. <br />Y <br />11 LNGINEER UESIGNE /ALTERNATIVI= <br />YSTEM ^ DESTRUCTION <br />0 OTHER <br />NUMBER OF EMPLOYEES: <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />I]-T� SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0 LEACH LINES U LEACHING CHAMBERS <br />SC <br /># OF LINES <br />LENGTH OF LINES ft <br />DISTANCE To NEAREST <br />WELL <br />it <br />FOUNDATION <br />ft PROPERTY LINE ft <br />FILTER EKED 1n11DTH <br />ft LENGTH <br />ash <br />_Remitted <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />It PROPERTY LINE AA ft <br />C' MOUNDED WIDTH <br />_ ft LENGTH <br />_ <br />ft DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNLiA T ION <br />ft PROPERTY LINE <br />C�1 SUMPS WIDTH <br />ft LENGTH <br />ft DEPTH _ ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY Lt�+{�._ %nfn it <br />13 DISPOSAL PONDS WIDTH <br />ft LENGTH _ <br />ft DEPTH �'qQU ft <br />TO NEAREST <br />' WELL <br />ft <br />FOUNDATION <br />ft PROPERTY I l �rjj ft <br />SER FW, <br />TWIDTH <br />ft DEPTH -- - vcN—"`"*r�1�47R`� ft <br />EXPIRl <br />f DO NEAREST <br />WELLft <br />FOUNDATION <br />ft PP.OPERTY LINE ft <br />1 HEREBY <br />CERTIFY <br />THAT <br />1HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAP( JOAQUIN COUNTY ORDINANCES, <br />s ATE LAWS AND RULES AND <br />REGULATIONS <br />OF SAN JOAQUIN <br />COUNTY. <br />SIGNED � 04/e-4!2-, TITLE OL6//4,'9Z- DATE <br />c PARTMEA - /S O LY <br />Application Accepted By - — Date-���r - Arcz / Employee ID# <br />Final inspection By _ _ Date D SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: _ _ Pit/Sump Soil Character: _ <br />COMMENTS ('.OI AAft;r -- a -r o l��.� <br />Y- - <br />PE <br />SC <br />Received <br />Check{f/ <br />Amount <br />Permitl <br />ID# <br />_Code <br />INFO <br />B <br />ash <br />_Remitted <br />Date <br />_Service Request 4 <br />PER fit <br />47-n I g�Ole ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/'1 g 6W <br />