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®NSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />kN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />nN-REFUNDABLE PERMIT CALL (209) 953-7697 Fort INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />)B ADDRESS <br />ROSS STREET <br />APN <br />CITY/ZIP <br />Q9 3 $ ado PARCEL SIZE S <br />WNER NAME / / J <br />WNER ADDRESS 1 Il/(O � © Voti 175 iw- 90' CITY/STAT <br />ONTRACTOR <br />PHONE <br />PHONE 9/.S�, L ✓� <br />T <br />ONTRACTOR ADDRESS / 1 7 ,=),� KM 1 y\) 14 >7's '4wE(3 CITY/STATE/ZIP bxj� ,04j) <br />ICENSE ❑LIC 42 ❑CIC -36 OTHER } t la NUMBER 07 7 EXPIRATION DATE <br />VATER TABLE DEPTH: J J - y ft <br />PERC TEST # BUILDING PERMIT # <br />YPE OF WORK: ❑ NEW INSTALLATION <br />)1 REPLACEMENT till11 J I Pees 11 Nei <br />GEOGRAPHICAL INFORMATION: COOrdlnateS X <br />VSTALLATION WILL SERVE: RESIDENCE ❑ <br />NUMBER OF LIVING UNITS: <br />LAND USE APPLICATION #_ <br />REPAIR/ADDITION ❑ ENGINEER <br />OUT -OF -SERVICE SEPTIC SYSTEM C! DESTRUCTION <br />COMMERCIAL �Q�17}1�DE: <br />Y <br />pp I [I OTHER <br />NUMBER OF BEDROOMS: T) pie pp NUMBER OF EMPLOYEES: <br /># OF COMPARTMENTS <br />/ALTERNATIVE <br />SEPTIC TANK TYPE/MFG �`'�(� CAPACITY: gal <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS � r <br />DISTANCE TO NEAREST: WELL //0 t ft FOUNDATION /of ft PROPERTY LINE % ft <br />LIFT STATION SIZE TYPE OF PUMP LlPKG TX PLANT El SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />d �rr+ll,v� <br />. <br />� LEACH LINES ❑ LEACHING CHAMBERS # of LINES _�• LENGTH OF LIhIES /Op ft <br />DISTANCE TO NEAREST WELL 00 ft FOUNDATION ft PROPERTY LINE ft <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />7 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />3 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />2 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN 20UNTY, <br />VIC IIVJf C`1.,1�1�V1yV�J - rLGr+JL %+r+�c- I�.vr+i c/+�+�+-�W�..•_ }n <br />MEN No No <br />mm mm <br />SIGNED <br />f111Q1 Ill,Pc�.u�ll vy <br />Character of Soil to <br />COMMENTS 121 <br />1■MME■E■ME�AfiJf'rt,!iii■.�ICma <br />!■■■■■■■■I'■■■■■■11■■■■■ <br />1■■■■■■■■t■'Llli■■■■■■■\0[0ilIl■■■■! <br />�!�lu':I/��■��■■■■■■ <br />1 <br />■ONE <br />■■■■■■■■I/■^I�I!.�J■11, <br />�i■■i■'�iiafi�il■■■II■■■■■■ <br />10 <br />■FARC�■l�f�liM��1_11�■■�:■�II��J■■I■R��■■■■■■■■■■■■■■■■■■■ <br />1■■Mr■■!�■■:��i1�71�■■1�■■■!7■■■■■■■■■x.71■■■■■r*■■■■ <br />IMi■■■■■■MEMO■\WMA <br />NO <br />\Irl■<LL�I■Li■1�■■■■i`3��+��r�1 <br />1■:uI!!■■■E■■■■i■■;■EIE■■■M■I■!l■■■■1!■■l�iii[] <br />whim <br />ilii■EI1!fEll�1�:!I■/�'�E■FIJI!!■Ma■!r'■�.'iii�!! <br />1 <br />rago <br />►*��/■tE�JI�eEF►�'J■Ofd!■IE' <br />'%�1�■■ <br />�E■EEi <br />MINE <br />WE <br />�E■EL���1�:�1E�iri■fiif�il�i��lilli�_ <br />rEflEfflfiflJi���.l�i�■ii�e�i■■IiiII��E■ <br />nel rvl, '� 91-311 <br />loc�a}17tt 5rGp f 1 <br />— vPit/S map Soil Character: <br />I <br />PE SL rtecervea i.l,ecnrr, A111VYDate <br />Code INFO By Cash Remitted Service <br />4 3:o0 <br />a� <br />4114/18 <br />Cot 1 l l' <br /># I Invoice # <br />Permit ID# <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />