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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOACUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESSSAA[.^^r��LYiG_---_—_CIITTYYIZJP CROSS STREET _ 077— A? APN /�C// PARCEL SIZE OWNERNAME AF=Cp/�CAiL/1 /l /�CLL� _-_________,_- _ PHONE p. OWNER ADDRESS O/DG/ T�� /C {% _ .__CITY/STATE/ZIP CONTRACTOR A) PHONE 6 o CONTRACTOR ADDRESS CITY/STATEIZIP LICENSE LAIC -42 I C-36 OTHER NUMBER __ _ - _ — _EXPIRATION DATE PIER Mme,= WATER TABLE DEPTH: � R GEOGRAPHICAL INFORMATION: Coordinates X _ U PERC TEST #_ BUILDING PERMIT # LAND USE TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION TION TERNATIVE 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 JOAQUIN COUNTY. VrS IIY13rCl111VIYJ - rLCHJC VHLL ILV: TITLE DATE Flltal Inspection tty _ UateLI JY IAL reKmI I - Approvea Dy Character of Soil to Depth of 3 Ft: Pit/Sump Soil C ct COMMENTS t-e(—jK Z,0 U 3 _ 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114118 0 C v N REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION V INSTALLATION WILL SERVE: C1 RESIDENCE 1.1 COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL_ It FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) ��'i2E \\ffLHING ❑ CHAMBERS LEi�[V1�� #OF LINES LENGTH OF LINES ft 4r� ii Q TANCE TO NEAREST WELL Y _ R FOUNDATION _ it PROPERTY LINE_ p ft ❑ FKI WIDTH It �DISTANCE LENGTH R DEPTH i TO NEAREST WELL R FOUNDATION ft PROPERTY LINEMDED WIDTH It LENGTH ft DEPTH —_c DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTYLI`_ J 2n. fl ❑ SUMPS WIDTH ft DISTANCE TO NEAREST WELL LENGTH ft DEPTH �7��VA Q(T"�� 7� It ft PROPERTY LIb(PF1_,"v'RO� ft FOUNDATION C3 DISPOSAL DISPOSAL PONDS WIDTH ft LENGTH R DEPTH pr R DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE It 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 JOAQUIN COUNTY. VrS IIY13rCl111VIYJ - rLCHJC VHLL ILV: TITLE DATE Flltal Inspection tty _ UateLI JY IAL reKmI I - Approvea Dy Character of Soil to Depth of 3 Ft: Pit/Sump Soil C ct COMMENTS t-e(—jK Z,0 U 3 _ 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114118 0 C v N