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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 3' <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDA E PERM11 CALL 209 953 97 FOR INSPECTION EXPIRES Y R F OM DATE ISSUED <br /> Joe ADDRESS r' CIITYYIZIP` f <br /> CROSS STREET APN 3-230- PARCELSIZE { •� '� <br /> OWNER NAME � }gyp <br /> � PHONE Q6q-4�p+�j/j � <br /> OWNER ADDRESS A CITY/STATE/ZIP l.� -I� y <br /> CONTRACTOR r, �F], P31 L^y1/elC-�.y �� �1�y�Q� PHONE <br /> CONTRACTOR ADDRESS w CiTY!STATE21P <br /> LICENSE IXC-42 ❑❑C-36 OTHER A NUMBER16t)L L , EXPIRATION DATE Y <br /> WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION, REPAIR/ADDITION it ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT 1 OUT-OF-SERVICE SEPTIC SYSTEM )< DESTRUCTION O�-D'M -`Je— <br /> INSTALLATION WILL SERVE, RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL T R FOUNDATION_ _ it PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP _ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS / #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH it LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE it <br /> i 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 /> I HOOV AdaNW,%qUCE R QUIRED FOR I PE FION -.PLEASE CALL 209 53-7697 <br /> SIGNED � TITLEA�M[,AMWADATE <br /> a, .Q <br /> Ty <br /> Ad <br /> :NT <br /> DEPARTMENT I! <br /> Application Accepted Date .3 3 Area EmployeeID# �S!�POu� <br /> Final Inspection By Date 3 3i ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to depth of 3 Ft: P Sump Soil Character: <br /> COMMENTS 00:— 9 P-.4G€ Sh,07'e• -}-nle— G-ES5 7?f4--J [OV FT r2o'Y WSL-L Bt. �T.' <br /> 4FS <br /> WE.« '4�D F K-ISTz^) pg-IiE�&/u /V + i <br /> (L <br /> PE SC Received Check#/ Amount Permit,Code INFO B as Remitted Date Service Request# Invoice# Permit ID# <br /> +-2io II5 HS�D 2S7•JT� �3 R 71o$FS� <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4124/12 <br />