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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1666 E. HAZELTON AVENUE • STOCKTON rA OS7nS . r'JnOI ARR_ZAIr <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS IE�XPPII}R�ESSY1 YEAR FROM DATE ISSUE <br />JOB ADDRESS CrrY1zIP \f JL.f�I LJI 1 <br />CROSS STREETtry /� Z-0/� APIN i 7 �9 l 3 �, I PAA,R�CELjSIIZE <br />P Q <br />OWNER NAME W� 1 I 1 )— PHONE � 1��67" � -777D <br />OWNERADDRESS �'•�•/C� T L )7F <br />Jom_^CITYISTATEJZ1P <br />CONTRACTOR J PHONE /6 / � —;� z,) � jJ ,✓/�,743 :/1 ,.µ <br />CONTRACTOR ADDRESS z —CITY/STATE/ZIP i5of 2.—•.) <br />40 <br />LICENSE '_1 C•42 ❑. C36 OTHER A NUMBER 35l -7 EXP3ATON DATE2 vZ✓ <br />WATER TABLE DEPTH: fJ / ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />G PERC TEST # FIBUILDING PERMIT # JOS .:, 1-1-,.' LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION _. ENGINEER DESIGNED IALTERNATNE <br />REPLACEMENT OUT•OF-SERVICE SEPTIC SYSTEM - DESTRUCTION <br />INSTALLATION WILL SERVE: Vf RESIDENCE <br />❑ COMMERCIAL <br />E OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />1 <br />1B SEPTIC TANK <br />TYPUMFG <br />-L <br />CAPACITY 1200 <br />•7 <br />gal # OF COMPARTMENTS L— <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal It OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL , % <br />ft FOUNDATION <br />ft PROPERTY LINE <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />Cl PKG TX PLANT <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />V LEACH LINES <br />-_ LEACHING CHAMBERS <br />Z it O- LINES <br />LENGTH OF LINES 55 R <br />DISTANCE TO NEAREST 'HELL <br />ft FOUNDATION <br />(,-- <br />ft PROPERTY LINE <br />❑ FILTERBED <br />WIDTH ISL="r ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />it FOUNDATION <br />ft PROPFJtI Y LINE R <br />❑ MOUNDED <br />WIDTH R LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEARES T WLLL <br />ft FOUNDATION <br />R PROPERTY LINE ft <br />Cl SUMPS <br />WIDTH ft LENGTH <br />ft <br />DEPIH R <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE R <br />❑ DISPOSAL PONDS WIDTH ft LENGTH <br />R <br />DEPTH it <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />R PROPER I LINE ft <br />id SEEPAGE PITS <br />NUMBER f— WIDTH <br />3to <br />R <br />DEPTH 2-5 R <br />DISTANCE TO NEAREST WELL 1'-�: <br />ft FOUNDATION _�] <br />'(' <br />R PROPERTY LINE S 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 COUNTY. <br />Application Accepted By — —z - <br />Final Inspection By ,_ <br />Character of Soil to Depth of 3 Ft: <br />COMME TS A til J E Z -rI .,, r <br />I*. (I Vi- intil G ,� CtL-f-t-r►u <br />Date <br />-_ <br />Area r Employee ID# A (7 <br />la Z ❑ SPECIAL PERMIT -Approved by <br />Pit/ ump Soil Character: <br />42_01 n <br />414116 <br />l <br />Invoice # Permit ID# <br />3 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />l fit 1 �l <br />