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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)488-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> J/y/�p�•ADDRESS 1 -__ __.._ Dn h._Q—__opomp! zr-D.[ -�}QS _.-_.s�2_2157 <br /> .OSSSTREEELET 4yl uJy •. �j -_ _. APN_D_'3'1 I I O ` ________—PARCELSaE- <br /> OWNER NAIllf L <br /> OWNER ADDRESS -j����_ '-.. LLA_L,Lt__-s7L•!—=ZYL _-.-. - CFTY/STATEMP, r'_�_ <br /> PHONE <br /> CONTRACTOR ADDRESS - -_ ...._-.______-_--__ _.._____.__CITY/STATE/ZIP _ _-- <br /> LICENSE ;L'IC-42 Ll 'C-36 OTHER. NUMBER_ _-_.__._-.ExPiRATION DATE__—__ <br /> WATER TABLE DEPTH: _ __n GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 1 PERC TEST • _._ BUILDING PERMIT#� -___.-.. LAND USE APPLICATION <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADDrT10N t I ENGINEER DESIGNED/ALTEERNATTr4E <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM II( DESTRUCTIONjr�.tG'=-L�_ <br /> [ INSTALLATION WILL SERVE: RESIDENCE I COMMERCIAL Ll OTHER-_—____-� <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: _-._ NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG 1�~__-_ CAPACITY �w A/ gal 10F COMPARTMENTS <br /> � <br /> ❑ GREASE TRAP TYPFJMFG _._ , _ CAPACITY gal NOFCOMPARTMENTS_�-__ <br /> DISTANCE TO NEAREST: WELL __'Y it FOUNDATION�_-_ it PROPERTY LINE /0 it <br /> ❑ LIFT STATION SIZE _._TYPE OF PUMP__-_ ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES i 1 LEACHING CHAMBERS------- N OF LINES LENGTH OF LINES __ � it <br /> ----_-_--__-- <br /> DISTANCE TO NEAREST WELL__�QO_5 It FOUNDATION� It PROPERTY LINE_ n <br /> ❑ FILTER BED WIDTH-_--___--it LENGTH__-- n DEPTH ---_ _--_---- it <br /> DISTANCE TO NEAREST WELL -_-__ it FOUNDATION It PROPERTY LINE__ ._- _ It <br /> ❑ MOUNDED WIDTH___- _ _it LENGTH --- - it DEPTH__—__- .._ it <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE_ __—it <br /> SUMPS WIDTH __. ____it LENGTH it DEPTH. <br /> it <br /> DISTANCE TO NEAREST WELL it FOUNDATION n PROPERTY LINE— — It <br /> ❑ DISPOSAL PONDS WIDTH n LENGTH.__ __ _—n DEPTH it <br /> DISTANCE TO NE A EST WELL 1 FOUNDATION n PROPERTY LINE C-_-_-____---_-_.-_--it <br /> SEEPAGE PITS NUMBER_-_- WIDTH to n DEPTH it <br /> DISTANCE TO NEAREST WELL IDf►�--_ FOUNDATION YD it PROPERTY LINE_- /O it <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY. <br /> INIM 4 H UR VANCE NOTICE RE UIRED FOR INSPE NS-PLEA <br /> -7 97 _ <br /> SIGNEf� '^ TITLE --._----_-_-._ OATE� <br /> sl <br /> JJ- <br /> N <br /> P FiTk _ <br /> Aece� Date <br /> ApplicationIT/ Y - - i_ Area �� Employee IDS_-��kbe <br /> Final Inspectio B _ - Date - --- --- I I SPECIAL PERMIT-Approved by <br /> Character of Soil to th of 3 Ft:___ Pit/Sump Soil Character: <br /> COMMENTS _—Zb <br /> PE SC Received ke/ Amount pate Permw Invoice s Permit IDS <br /> -- <br /> Code INFO _ B Caa Remitted _Service Request• <br /> Q a LID 2 "� CC' 7/ <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4124/12 <br />