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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN C0I1NTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE-STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS y� EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 5VI _ ._.((��'�rye/CRY//ZI/P'�n��sCRo7S STREET (�,. APN `�I Li �% Y7 / PARCEL SIZE / • `'S OWNER NAME 41 rJ ll'7I /y �1 (�f2e /\ PF1pN[ OWNER ADDRESS V/^N.T r (.e 9 0'^'V V'e. CM/STATE/ZIP �r �7 q CONTRACTOR u/BS� C. ()a-f�" (�Q,GJC _ham 1 n G PHONE -2m. ) /� 1 ' // 3q ,11 CONTRACTOR ADDRESS 13 / ► I(A. X � 1 ( ( CITYISTATE/Z1P � J) D I, C�rI 95'2-q d LICENSE C42 _ C36 OTHER NUMBER V v I EXPIRATION DATE_ WATER TABLE DEPTH: 920 f? L ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT /F LAND USE APPLICATION TYPE OF W RK: NEW 114STALLATION V REPAPJADDITION ENGINEER DESIGNEC /ALTFRNATNE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ESIDENCE COMMERCIAL OTHu2 NUMBER OF Limn. UNITS: NUMBER OF BEDROOMS' NUMBER OF EMPLOYEES' ❑ SEPTIC TANK TYPFJMFG CAPACITY gal # OF COMPARTdENTS ❑ GREASE TRAP TYPE/M°G CAPACITY pal # OF COMPARTMENTS DISTANCE TO NEAREST: %AFLL ft FOUNDATION It PROPERTY LINE ft ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) a- LEACH LINES LEACHING CHAMBERS 1 r 1T1•' l rQ.-7 O i S # or LINEA ( LENGTH OF LINES S J ( fl 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAONN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 7-� DEPARTMENT USE ONLY Application Accepted By /�-- 1 L Date 1 /y ✓ Area �Cj Employee IDA Fr,,, Final Inspection By >fL�1A.�SLL (�fllc�t.,� ti"L Date �'%_`)�7j: _ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: PWSump Sall Character - COMMENTS Fc11 lIYI( s"+rM , 91I7 TiYE— /TLiu/?' 15�0"ifA/ 771-1 f1 C rlAien kWrW PE NF Recaved ChecM Amount Code PennN Involve # Permit ID# Code INFO Qy mCash Remitted % Service Request # `'TMV 1 q-� ONSITE WASTEWATER TRT SYSTEM PERMIT 4/1414118 DISTANCE IO NtAREST WELL It FOJNDATION 10.1" It PROPERTYLIhE �J'f ft ❑ FILTER BEU WIDTH ft LENGTH ft DEPTH p DISTANCE TO NEAREST WELL ft FOJNDAT10N _ ft FROPERTYUNE fl ❑ MOUNDED WIDTH ft LENGTH It DEPTH p �j L� DISTANCE TO NEAREST SUMPS WIDTH I WELL If FntNDATION / r ft FROPERRTTYUNC fl p LENGTH ft DEPTH Z' fl DISTANCE TO NEAREST WELL (I YRUPERTYLINcf-r fl ❑ DISPOSAL PONDS WIDTH rl LENU IH It DEPTH p DISTANCL IO NEAREST WELL It FOUNDATION ft PRO-ERTYUN--ft RRF 0—P I n DISTANCE TO NEAREST WELL { p 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAONN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 7-� DEPARTMENT USE ONLY Application Accepted By /�-- 1 L Date 1 /y ✓ Area �Cj Employee IDA Fr,,, Final Inspection By >fL�1A.�SLL (�fllc�t.,� ti"L Date �'%_`)�7j: _ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: PWSump Sall Character - COMMENTS Fc11 lIYI( s"+rM , 91I7 TiYE— /TLiu/?' 15�0"ifA/ 771-1 f1 C rlAien kWrW PE NF Recaved ChecM Amount Code PennN Involve # Permit ID# Code INFO Qy mCash Remitted % Service Request # `'TMV 1 q-� ONSITE WASTEWATER TRT SYSTEM PERMIT 4/1414118