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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENviRONMENTAL HEALTH DEPARTMENT 1866 E. HAZELTON AvENue -STOCKTON CA 95205 -(2091468-3420 NON-REFUNDABLE PERMIT CALL 209)953-7897 FOR INSPECTIONS EXPIRES 1 YEAR FRDu DATE_ ISSUE_ D JOB ADDRESS ^)1L. CITY/ZIP CROSS STREET L' vi,� �"? v r i APN 14N -<� o LlJf t OWNER NAMEBruce- Q-�,yys6� kf' f lJ PARCEL SIZE I, s � N[ A /� OWNER ADDRESS Pp V 0.1 (CrryISTATE/ZIP !-Deko f�iC�/ "/,57x37 CONTRACTOE Q tl� PHONE 1 •_. �- a� l CONTRACTOR ADDRESS �7 �J {� A,V.y�YVQ \1 �T, CRyI$TATFJLP ._ `ORI + 062-40 LICENSE :. C42 C-36 OTHER �_ NUMBER ExPtRATw. DATE WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: F:IN INSTALLATION REPAIRIADDITION ENGINEER DES IGNEDlALTHiNATrvE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION GME INSTALLATION WILL SERVE: RESIDENCE / CONMERCUIL f' OTHER NUMBER OF LN'NG UNn5: 1'1 t NUMDER OF BEDROOMS: _ NUMBER OF EMPLTTYFFC: L 4 SEPTIC TANK TYPE/M=G •1' V^ ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WCLL O LFT STATION SIZE TYPE OF PUMP CAPACITY L�/O_ . -_ gal # OF COIAPPRTUFNTR-2—_t CAPACITY gal iF OF COPAPPRTMENTS ft FOUNDATION ft PROFERTY LINE ft .J PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) iA LEACH LINES LEACHING CHAMRERS 1 y �7 Y4'tVV S 0 of LINE3 Z LENGTH OF LiNFs (CLQ it I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WALL SE DONE N ACCORDANCE WITH SAW JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY - E1 I� �I • DEPARTMENTUS ONLY /� Application Accepted B Z Dab a .� Area 7 e Employee 9T# /3 Final Inspection By -DataZI SPECIAL PERMIT -Approved by Character of Soil to Ds of 3 Ft PfllSMmP Sal Character, COMMENTS "eoirst wi en -6s:y, f4'✓v1- IVntLo / r r� .V j:J le i%►rlP.s �,: 11 rn r n, l►, i...n yr o . PE ICA 42-01 4,!14)18 Remitted I I -j" I Service 0 t' I& Cff IV49-77fked 0I1 bp f r�I FSK rnP Cii Invoice # Permit IDN ONSITE WASTEWATER TR-MNT SYSTEM PERMIT DISTANCE TO NEAREST WELL H FOUNDATION ft PROPERTYLINE ft O FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION _ ft PRO-ERTYUNE ft U MOUNDED WIDTH N LENGTH - R DEPTH it DISTANCE TO NEAREST WELL It FOIINOATICN ft PROPERTY UNE ft Cl SUMPS WIDTH It LENGTH R DEPTH it DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH R LtnciH `t DEPTH ft DISTANCE IU NEAREST WELL ft FODUNC_ATION ' ?�ll ft PROPERTY JNE ft SEEPAGE PITS NUMBER WIDTH ft DEPTH_. 251 ft DISTANCE TO NEAREST WELL B FOUNCATION ft PROPERTY UNE R I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WALL SE DONE N ACCORDANCE WITH SAW JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY - E1 I� �I • DEPARTMENTUS ONLY /� Application Accepted B Z Dab a .� Area 7 e Employee 9T# /3 Final Inspection By -DataZI SPECIAL PERMIT -Approved by Character of Soil to Ds of 3 Ft PfllSMmP Sal Character, COMMENTS "eoirst wi en -6s:y, f4'✓v1- IVntLo / r r� .V j:J le i%►rlP.s �,: 11 rn r n, l►, i...n yr o . PE ICA 42-01 4,!14)18 Remitted I I -j" I Service 0 t' I& Cff IV49-77fked 0I1 bp f r�I FSK rnP Cii Invoice # Permit IDN ONSITE WASTEWATER TR-MNT SYSTEM PERMIT