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D ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA95205 .(209) 468-3420 I`IVN-RtFUNUAE+LE YtKMIt GA L (ZU.9) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE 4462 JOB ADDRESS CITYIZIP VI CROSS STREET t/E [U�y APN 1X L,f /yL�( PARCELSIZIE /] AJC' OWNER OWNER ADDRESS CITYISTATE/LP /( CONTRACTOR Aa/� � I,1JA�,Wp 1��/` _ I rC.. PHONE 7-Ucf' 31-)9 --73947 CONTRACTOR ADDRESS _-33 AAI `' (�� CRYISTATEIZIP i',, Cj? 95-(-40 LICENSE LI --.C-42 ..-C36 OTHER !1 NUMBER ExPIRAnON DATE lOi�J WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y G PERC TEST Y BUILDING PERMIT# LAND USE APPLICATION # r rc ur ry ur<n: / NEW INSTALLATIONN REPAIR/ADOMON ENGINEER DESIGNED I TERNATIVE y REPLACEMENT OUT -0F -SERVICE SEPTIC SYSTEM X DESTRUCTION IZ 1 INSTALLATION WILL SERVE: L RESIDENCE C COMMERCIAL L OTHER NUMBER OF LIVING UNITS: NUMBER OF/BEDROOMS: 3 NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG ti61 . CAPACITY 2-00 gal # OF COMPARTMENTS ❑ GREASETRAP TYPE(MFG t CAPACITY gal # OF COMPARTMENTS�.�— P�r rn1ri)`yY�m uSfu / 4DISTANCETONEAREST: WELL T ft FOUNDATION iOt ft PROPERTY LINE _ tl ❑ ❑FTS'TATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST 'NELL R FOUNDATION it PROPERTY LINE ft ❑ FILTER BED WIDTH I ft LFNGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE R ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH _ ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ SEEPAGEPITS NUMBER WIDTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE (I I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPIJCATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. DEPARTMENT `; EONLY 1 (, , Application Accepted — r Date � `v ° ) Area Employee ID#� _ Final Inspection By Date �J 1 ( L SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: I Pit/Shnp Soil Character: COMMENTS' P0 IJ L -W L'T" PE SC Rated I Check*/ I Amount to Permit/ Invoice # Permit ID# Code INFO Ceah Remitted Service "u8st # 42-01 �� j��/ 4/14,18 nW 12 / 7J,39�3 ONSME WASTEWATER TRTMNT SYSTEM PERMIT c u /V N l r T MCNT