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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOACUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AvENuE-STOCKTON CA 55205-(204)4".3420 <br /> NON-REFUNDABLE PERMIT CALL209 <br /> J 953-7697FORINSPEcnoNs EXPIRES 1 YEAR FROM DATE ISSUED <br /> .ioe ADDRESS 350 E_CritChett Ave. CI7YRJP T-CY 95304 w <br /> R <br /> CROSS STREET Kasson APN 241-110-40 <br /> PARCEL Sri 2 AC- e <br /> OWNER NAME rJb Robert Smith - <br /> PRONE(916)229-2424 � <br /> OWNER ADDRESS P O.Box 22748 CITYISTATE0P Sacramento,CA 95822 <br /> CDNTRAGTOR LJve Oak GeoEnvironmenlal PHONE( 1359-0375 <br /> CONTRACTOR ADDRESS 407 W.Oak St CrrY1STATEMI,Lodi,CA 95240 <br /> LICENSE ❑CC-42 ❑UCa6 OTHERCEG NUMBER 2151 E%PIRATION DATE <br /> WATER TABLE DEPTH. ft GEOGRAPHICAL INFORMATION: Coordinates X y <br /> PERC TEST 1Y 6UILDING PERMITS LAND LOSE APPLICAT10N <br /> TYPE OF WORK: C New INSTALLATION D RPPAUN/ADDFoON ENGINEER DESIGNED IALTERNATIYE <br /> C. REPLACEMENT C OUT-OFSERME SEPTIC SYSTEM _ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIN NG UMTS; NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 13 SEPTIC TANK TYPEIMFG CAPACITY gal i OF COMPARTMENTS <br /> Q GREASE TRAP TYPVwG CAPACITY 9W *OF COMPARTMENTS <br /> DISTANCE TO NEAREST. WELL ft FOUNDATION ft PROPERTY LINE f[ <br /> LlLIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND CIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES - LEACHING CHAMBERS !OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WIEIL ft FOUNDATION ft PROPERTY LINE R <br /> 13 FILTER BED WIDTH It LENGTH ft DEPTH It <br /> DtsTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELLIt FOUNDATION ft PROPERTY LINE ft <br /> ❑ sumps WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL -ft FOUNDATION ft PROPERTY LINE ft <br /> 4 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> O SEEPAGE PITS NUMBER WIDTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDAPON ft PROPERTY UNE it <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANM, <br /> STATE LAWS ANO RL LES AND REGULATIONS OF SAN JOAOU IN C04JN TY- <br /> MINIMLim OYAW N12TICE REQUIRED FOR INSP CTIQN -PLEA CALL 7 <br /> SIGNED lKL5F 1'1TLE Project Manager DATE �- 2-— <br /> -------------- <br /> ALF <br /> D <br /> VNO, <br /> P A R T ME N T J1 12LY r <br /> Application Accepted By Date Area s 7 Employee IDS 05 <br /> Final inspection By Date 0 SPECIAL PERMIT-Approved 6y <br /> Character of Soil t0 Depth of 3 Ft PO)Sump Sat Character. <br /> COMMENTS <br /> PE SCReceived ec Amount Date PerrniU <br /> Code INFOI ev I <br /> 'ash Rrittedl Service uest# Invoice i Permit ID# <br /> .] i <br /> 42.01 <br /> 411411 B <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />