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/-_ $ ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOA UIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET - STOCKTON CA 95202 - (209)4613.3$20 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INsPECr/oNs EXPIRES 1 YEAR FROM DATE ISSUED JOBADORESS �/D3. 5.._—rsj`3 �• CITYY1ZtP e?,t �2__l CROSS STREET APN / IQl /y D / PARCEL S7 IZ,E OWNER NAME PHONE _Ly 1G.G OWNER � .1 ADDRESS CITYISTATEIZIP CONTRACTOR 4/✓J/Yr z L/i1�.0 /lG PHONr -L' 5 /]! �1' X0.2 % CONTRACTOR ADDRESS CITY/STATEIZIP LICENSE 9C-42 'IC -36 OTHER NUMBER�/St JY� EXPIRATION DATE 62--11-le WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y h i PERC TEST tY BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: 1.:1 NEW INSTALLATION REPAIR/ADDITION .. ENGINEER DESIGNED /ALTERNATIVE ft REPLACEMENT CI OUT -OF -SERVICE SEPTIC SYSTEM 0 DESTRUCTION — ft FOUNDATION ft PROPERTY LINE INSTALLATION WELL SERVE: i] RESIDENCE COMMERCIAL OTHER, It DEPTH NUMBER OF LMNG UNITS; NUMBER OF BEDROOMS: NUMBER OF EMPLOYES: DISTANCE TO NEAREST C3 SEPTIC TANK TYPEIMFG CAPACITY Z(YYj gal # OF COMPARTMENTS U GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE __,-ft O UFT STATION SIZE TYPE OP PUMP O PKG TX PLANT U SAND OIL SEPARATOR (ENCLOSED SYSTEM) 3� LEACH LINES LEACHING CHAMBERS # OF LINES _�_ LENGTH OF LINES 1616 h Permit 3Dlf — DISTANCE TO NEAREST WELL .i40 r ft FOUNDATION 2S - It PROPERTYLINE U FILTER BED W10TH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE tt 0 MOUNDED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It • SUMPS WIDTH it LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It • DISPOSAL PONOS WIDTH ft LENGTH ft DEPTH IT DISTANCE TO NEAREST WELL ft FOUNDATION —ft PROPERTY IS SEEPAGEPTTs NUMBER 6 WIDTH S-, ft DEPTH �S ft DISTANCE TO NEAREST WELL .sTLO I ft FOUNDATION 44 It PROPERTY LIME /SQ. ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED':C�` TITLE DATE i 3 Application Accu' Oate �� -`-Z -_ Area Emplayee ID# `l _ Final Inspection Be Date 13 SPECIAL PERMIT - Approved by Character of Soil t Depth of 3 Ft: PiUSump Soil Character: SC Recoivod C� INFO 8 ash ? '�-- Amount _ Remitted Dale Permit/ Invoice 0 --Service-Re uest #. _._.--- — off. Permit 3Dlf — _- E—E NNE 3 Application Accu' Oate �� -`-Z -_ Area Emplayee ID# `l _ Final Inspection Be Date 13 SPECIAL PERMIT - Approved by Character of Soil t Depth of 3 Ft: PiUSump Soil Character: 42-0i ONSITE WASTEWATER TRTMNT SYSTEM PERMIT a2211 n SC Recoivod C� INFO 8 ash ? '�-- Amount _ Remitted Dale Permit/ Invoice 0 --Service-Re uest #. _._.--- — off. Permit 3Dlf — _- E—E 42-0i ONSITE WASTEWATER TRTMNT SYSTEM PERMIT a2211 n