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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)46$-3420 <br /> N N-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> dOaADDRESS r .,743F-Cr' chett F- CITY/ZIP _ L <br /> CROSS:STREET Kasson Rd. APN :2tE _1rU- PARCEL SIZE Z-1 <br /> O <br /> OWNERNAME Tami Tavake +� PHONE I `�' -j6 24 <br /> OWNERADDRESS Tami Teltvaklb 989 Crichett CITY/STATE/ZIP Tracy <br /> CONTRACTOR Genes Septic Serv. PHONE ;4-0f- ..57;ZY— 6-Y.3 P <br /> CONTRACTOR ADDRESS 1 305 Avalon Ave. Modesto Ca. CITY/STAZBgestO Ca. 95351 <br /> LICENSE ❑ C •❑ C-36 OTHER A J NUMBER � EXPIRATION DATE <br /> i <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X _ Y <br /> 0 PERC TEST #� � BUILDING PER-MIT# d AND USE APPLICATION## <br /> TYPE OF WORK: NEW INSTALLATION 13 REPAIR/ADDiTION I] ENGINF.ERDESIGNED/ALT ERNATIVE <br /> ❑ RFPLACFMFNT,,K O DESTRUCTION <br /> INSTALLATION WILL SERVE: WRESIDFNCE O COMMERCIAL ❑ OTHER <br /> 10 NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 12. NUMBeR OF EMPLOYEES: <br /> SEPTIC TANK 'IYPEJMFG V1 ' CAPACITY g,-,l #OP COMPARTMENTS <br /> O GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION _ ft PROPERTY LINE ft <br /> - ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> .00 <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES . ft W <br /> DISTANCE TO NEAREST WELL� ft FOUNDATION ft PROPERTY LINE �� ft ,'/y 1 <br /> O FILTERBED WIDTH ft LENGTH ft DEPTH ft n <br /> DISTANCE TO NEAREST WELL_ ft FOUNDATION ft PROPERTY LINE ft ¢, <br /> O MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 SUMPS WIDTH ft LENGTH ft DEPTH ft • <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION ft PROPERTY LINE ft (' <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft Foui%'DATION ft PROPERTY LINE ft <br /> © SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft F'OUNDATTON fC PROPERTY LINE ft. <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADV NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED_ _ TITLF�`J DATE/Z-:- <br /> 1 <br /> #iLL <br /> .t, i. <br /> i. <br /> WFA <br /> G?d <br /> I <br /> 2 <br /> � - <br /> 4 r EPARTMENT E O - <br /> Application AcceptedBy Date Area Eritpjoyee ID# <br /> Final Inspection By Date 12/of 0 SPECIAL PERMIT-Approved by _ 4 <br /> Character of Soil to Depth of 3 Ft: a Pitisump Soil Character: <br /> COMMENTS lea - .. <br /> ..L-.Y tF' I <br /> IV <br /> rr3Zlz fcx 1cra- tarS_�tz tru :> r �r r'• t .i o �./ <br /> PG SC Received eek# Amount Permit/ <br /> Date Invoire# Permit ID# <br /> Code INFO B s Remitted Service uest <br /> i <br /> S a6S7aa, <br /> , <br /> ulvMl' WASTEWATT <br /> ER PERMIT <br /> 05/30/2007'Rei t/ �f'�'- �{fG/La L�w c or, [...t-rh ��cer . $ !sCc -cti1•l/ �De� `r�'r r red //�� ----- - - <br /> r ) i ���� C..�Y'1�C�• �DmInJ <br />