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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH D®ARTMENT 1868 E HAZELTOdt AVENUE - STOCKTON CA 95205 -12091468-3420 <br />NON-KEFUNDABLE PERMIT CALL 109 953-7697 FOR INSPEC770NS EXPIRES 1 YEAR FROM DATE ISSUE <br />Joe ADDRESS Z c <br />m/z.,. / <br />CROSS STREET \11�rCr,� `\\ilPr CV1L1Yl �(,Lj�Q - APN� (I l �'!� v / I i —PARCELSIZE f .`SC <br />'i <br />OWNER NAIVE_) 1\ lY 11 IYQ 1 yTU�u -, PHONE W'1 • 1�� � -1� I�� <br />OWNER ADOReS5 CrrYISTATEIhP <br />CONTRACTORy�le�1�� Cnd' c-aacno(��L, ��c PNGNE ? Lrl •1�_✓�I-1 ' �•�'t("�Y - <br />CONTRACTOR ADDRESS 33 �(M1[.yy� 11 �j"� CRYISTATFIZIP C� LS�Liu <br />LICENSE J .C-42 Jr'C36 OTHER_ NUMBER R51 1 <br />11 Exesn <br />uONDATE --2L2:-- <br />WATER TA&2 DEPTH: <br />ft GEOGRAPHICAL INFORKATION: Coordinatsa X Y <br />n <br />PERC TEST # <br />BUILDING PERMIT# <br />LAND USE APPLICATION # <br />TYPE <br />O <br />NEW INSTALLATIONf R6PAA/ADDn1ON <br />NOINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT t.t (.11 t-iC Ci [; OUT-0E-SERVICESEPTICSYSTEJ <br />DESTRUCnoN <br />INSTALLATION <br />WILL SERVE Raa1DY4C[ I] COMMERCIAL <br />(7 OTHER <br />NUMBER OF LjvNa UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ <br />SEPTIC TANK <br />TYPEIMFG CAPACITY <br />gel # OF COMPARTMENTS <br />❑ <br />GREASE TRAP <br />TYPEIMFG CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL R FOUNDAnoN <br />it PROPERTY LINE fl <br />LIFT STATION <br />SIZE - -TYPE OF PUMP (3PKG TX PLANT <br />O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />,O <br />`�O <br />LEACH LINES <br />�" 1J <br />.- LEACHING CHAMBERS �njq J-1Yd' oy,5 # OF LINES <br />Z LENGTH OF L[NES Lj it <br />DISTANCE TO NEAREST WELL IFS b it FOUNDAnON R PROPERTY LINE it <br />❑ <br />FILTER BED <br />WIDTH It LENGTH <br />ft DEPTH it <br />DISTANCE TO NEAREST WELLIt FOUNDATION <br />R PROPERTY LINE ft <br />❑ <br />MOUNDED <br />WIDTH It LENGTH <br />It DEPTH ry <br />DISTANCE TO NEAREST WELLR FOUNDATION <br />it PROPERTY LINE it <br />❑ <br />SUMPS <br />WImH ft LENGTH <br />ft DEPTH it <br />DISTANCE TO NEAREST WELLft FOUNOATION <br />ft PROPERTY LINE R <br />❑ <br />DISPOSALPONDS WIDTH ft LENGTH <br />R DEPTH ft <br />DISTANCE TO NEAREST WELLR FOUNDATION <br />ft PRnPERTYLINE R <br />Ed <br />SEEPAGE PRS <br />NUMBER Lt WIDTHI0') <br />it Orpnl <br />DISTANCE TO NEAREST WELL inO1 it FOUNDATION In+ <br />ft PROPER TY LINE <br />1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL SE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />c� <br />cop/ - <br />r� Z i DEPARTMENT US.E ONL. I C15 <br />Application Accepted By _'h_!l Date Area I/ > 3 Employee ID# j%'"�t <br />Final Inspection By Data C SPECIAL PERMIT.Approved by <br />Character of Soil to Depth of 3 Ft: I Pittsump Soil Character. <br />COMMENTS IT 1 -4,011147EXISF�'it' IMPS t Wt? )L ; C r_ ✓ 11'::c' I�N_� 'c. l01 <br />fv fotMb r' W I' f1 Biz of r S1r� <br />cvf PLY �,9 1 19('' <br />PE SC ReaaNad CheckAV AmoDM pate _ Permltl Imola # Permit IDA <br />Code INFO B Cash Remitted Servic�Ro <br />42-01/r 'L ONSITE WASTEWATER TRTMNT SYSTEM PER7Arr <br />4/14!19 y" / / r� <br />N�ONry <br />rtq NT <br />