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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95206 - (209) 468-3420 <br />NoN-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INspEcTioNs EXPIRES I YEAR FROM DATE ISSUED <br />Joe ADDRESS -CtTyfzlp <br />CROSS STREETAPN-_f J_ 71, 4 PARCEL SIZE <br />OWNER NAME C�tikIA1111 t&1Q, A.1 .......... PHONE <br />OWNER AooriEss CITYISTATEYZIP <br />CONTRACTOR PHONE <br />6L . . . . . . . . . . . . 149-5,21A <br />CONTRACTOR ADDRESS CITYJS7ATE17JP <br />LICENSE bdt_42 [30"6 OTHCR NUMBER EXPIRATION DATE /WA5/ <br />WATER TABLE DcPTH: <br />it GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />r .] PERCTEST # .... ....... <br />. <br />BUILDING PERMIT # LAND USE APPLICATION # <br />I <br />TYPE OF WORK: <br />r" New INSTALLATION REPAIR/ADDITION <br />0 ENGINEER DESIGNED /ALTERNATIVE <br />S - Ra qu at # <br />. ..... Rif <br />REPLACEMENT I OUT -OF -SERVICE SEPTIC SYSTEM <br />0 DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE D COMMERCIAL <br />fl OTHER <br />L NUMBER OF LIVING UNITS: Numsen OF BEDROOMS. V <br />NUMBER OF EMPLOYEES: _.j <br />0 SEPTIC TANK <br />TyPEjMrO 528-4 CAPAcrry <br />gal #OFCOMPARTMFNTS__ <br />13 GREASE TRAP <br />Typr-'WrG CAPAcryY <br />gal #orCOMF'ARTMENTS__ <br />It FOUNDATION <br />DISTANCE TO NEAREST: WELL ft FOUNDATION _ <br />ft PROPERTY LINE tt <br />(3 LIFT STATION <br />SIZE _TYPE OF PUMP 0 PKG TX PLANT 0 <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />I . . ........ .. ............ ....... ................... <br />LEACH LINES 0 LEACHING #OFUNES LENGTH OF LINES <br />DISTANCE To NEAREST WELL ft FWN0A1'ION — -ZIJ It PROPERTY LINE it <br />U FILTER BED WIDTH <br />ft <br />LENGTH <br />arm <br />it <br />DEPTH — it <br />DISTANCE TO NEAREST <br />WELL,,,,, <br />S - Ra qu at # <br />. ..... Rif <br />FOUNDATION <br />-ft <br />PROPERTY LINE ft <br />0 MOUNDED WIDTH <br />it <br />LENGTH <br />ft <br />DEPTH. it <br />DISTANCE To NEAREST <br />WEU._ <br />It FOUNDATION <br />It PROPERTY LINE It <br />CI SUMPS WIDTH <br />It <br />LENGTH <br />11 <br />DEPTH it <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />PROPERTY LINE ft <br />El DISPOSAL PONDS WIDTH <br />It <br />LENGTimi . <br />-ft <br />DEPTH it <br />DISTANCE To NEAREST <br />WELL <br />ft FOUNOATION <br />ft PROPERTY LINE—- It <br />SEEPAGE PITS Nui;AsER � WIDTH- 3 fit DEPTH ;.;?ft <br />DISTANCE To NEAREST WELL,,,,,,_,_ It FOUNDATION PROPERTY LINE _ /40 ft <br />I 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 COUNTY. <br />SIGNED <br />DEPARTMENTUSE ONLY <br />Application Accoptod By Data <br />16/7,4/y4 <br />'d <br />Final Inspection By Date <br />Character of Soil to'DOP6 of 3 Ft: --­...—­­ PIVSUMP Soil <br />COMMENTS A I-, _ _ " le d , <br />DATE <br />Area ZEmployee 100 <br />0 SPE IAL PERMIT -Approved by <br />PE Sc <br />Received Choi; <br />mount <br />Dote <br />arm <br />Invoice Ill Permit 109 <br />Code INFO <br />Bv- <br />Remitted ..4Z <br />S - Ra qu at # <br />. ..... Rif <br />kvo <br />;2- <br />f <br />00 <br />?100 1 <br />.... ........ <br />42-01 ONSITE WASTEWATER TRIVINT SYSTEM PERMIT <br />4114h8 <br />