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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE-STOCKTON CA 95205 - (209) 468.1410 <br />NON-REFUNDABLE <br />CALL 209 953.7697 FOR INSPECTIONS <br />ExPIRES 1g/YEAR RO�M IaSSLIED <br />F. <br />� rPERMIT <br />JOBADDRESS Ed.TrfTV <br />S% CITY/ZIP';*?(hV4 <br />1 <br />CROSS STREET 1IIIS <br />APN 1 p 11-7 O35 <br />gDATE <br />PARCEL SIZE <br />OWNERNAME i{btnn <br />WIDTH <br />PHONE <br />S <br />INSTALLATION WILL SERVE: RESIDENCE <br />OWNER ADDRESS <br />CITY/STATE/ZIP <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />CONTRACTOR Js Ca,S+-r�Ci,f� 3 stp.(-.� <br />/ <br />Sk. PHONE "7I(i- <br />-2?-'?-q19-7 <br />CONTRACTOR ADDRESS Va')? AcAfLLtC-, <br />-*Zn' CITYISTATE21P <br />S�Y,W�Emy / IS -8'Z8 <br />LICENSE 'C.42 1636 OTHER p' <br />NUMBER %ZZySL/ EXPIRATION DATE <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />PERC TEST 0_ <br />BUILDING PERMIT # <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />_ NEW INSTALLATION <br />REPAIRIADDrnoN <br />ENGINEER DESIGNED/ALTERNATIVE <br />WIDTH <br />REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE <br />✓ COMMERCIAL <br />OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES:_ <br />®J SEPTIC TANK <br />// 9 <br />G _.Lqq 4' <br />TYPEIMF1 DD ` L <br />CAPACITY IZOG <br />gal #OFCOMPARTMENTS 2- <br />0 GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF CONIPARTMENTS <br />� <br />` �/� <br />DISTANCE To NEAREST. WELL <br />ft FOUNDATION <br />it PROPERTY LINE R <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />1 i LEACH LINES <br />✓ LEACHING CHAMBERS # OF LINES 4 -3 <br />LENGTH OF LINES it <br />Date <br />Inv°Ice# Permit IDN <br />DISTANCE TO NEAREST <br />WELL. I Ccs '� ft FOUNDATION 20 <br />ft PROPERTY LINE IoO' ft <br />A <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH It <br />DEPTH ft <br />r <br />DISTANCE TO NEAREST <br />WELL ft FOUNDATION <br />R PROPERTY LINE R <br />13 PriOUNDED <br />WIDTH <br />fl LENGTH ft <br />DEPTH fl <br />� <br />` �/� <br />13R <br />SUMPS <br />DISTANCE TO NEAREST <br />WIDTH <br />WELL it FOUNDATION <br />LE <br />LENGTH R <br />R PROPERTY LINE it <br />DEPTH It <br />��� io <br />DISTANCE TO NEAREST <br />bti$L R FOUNDATION <br />R PROPERTY LME <br />❑ DISPOSAL PONDS <br />WIDTH <br />R LENGTH R <br />DEPTH <br />DISTANCE TO NE REST <br />WELL It FOUNDATION <br />R PROPERTY LINE <br />1 <br />R <br />�' / COO <br />in/ SEEPAGE PITS <br />NUMBER_ <br />WIDTH �iy' t <br />DEPTH Z 5 ft <br />/ Q <br />Fp �TY <br />DISTANCE To NEAREST <br />WELL ISO- R FOUNDATION VO <br />+ <br />R PROPERTY LINE 100 R <br />RNTq <br />TM <br />I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />NT <br />STATE LAWS <br />AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />t DEPARTMENT VSEDNLY <br />Application Accepted By . ` Date:JU�Zqjol <br />GArea y Employee ID# <br />Final Inspection By Date = ` SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of Ft:PIUSympSo�11 Character. <br />COMMENTS gu:�P.li>/lt Fo ho ►SG2�NYIPL4PG7 trDr�► �virentsep��c tys ew► <br />PE <br />Sc Received CheckplAmount <br />Date <br />Inv°Ice# Permit IDN <br />Code <br />INFO BY, Cash <br />emitted <br />Service Request If <br />s <br />a$i <br />a <br />�n <br />42-01 <br />4/118 / r O3J CJ`I ONSITE WASTEWATER TRT'AINT SYSTEM PERMIT <br />