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IAI = 3;It? -rte` k�lwl S��-G-17 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT --AA / ��C/�A�•LL (n209 953-7697 FOR INSPECTIONS �+ EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 4 �Q5 T, AA(Aff &1KQM + �I CITY/ZIP l� VD r LkOV) C5 21 5 - CROSS STREET q APN - z-- PARCEL SIZE j f e OWNER NAME ^^ �/ 2 PHON 5 11 2-1d�/-'se-4 's e- C7 j OWNER ADDRESS 'l) X 2 J CITY/STATE/ZIP fp 6� 14"1 V O A LIT �JI CONTRACTOR ' / PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑ C-42 ❑ C-36 OTHER NUMBER EXPIRATION DATE (' ► WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # I I BUILDING PERMIT #M- I I tC1 W LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION R PAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG epr CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE I D !r ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. ►v►►►v ULj ► cY vn) J4L�'V r►va.c ►vv►►a,.c ncwv1nc1-1 rvn nvarca.►►v►va - VL- rMoc L MI -L- rcv SIGNED 71� (/ / C TITLE DATE 11jin r A rf / IVI t IV 11 V J r V N L r �'�• Application Accepted eyf Date Area Employee ID#�� Final Inspection By Date ❑ SPECIAL PERMIT - Approved by Character of Soil to gepth of 3 Ft: Pit/Surrfp Soil Character - COMMENTS PE LEACH LINES LEACHING CHAMBERS # OF LINES - LENGTH OF LINES d U ft INFO DISTANCE TO NEAREST WELL ( ft 1 FOUNDATIONIV Ik ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH 3 cein ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH 4zit ft DEPTH /I/r ft DISTANCE TO NEAREST WELL L Cib - - ft FOUNDATION 1 ^ ft PROPERTY LINE I -I' ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. ►v►►►v ULj ► cY vn) J4L�'V r►va.c ►vv►►a,.c ncwv1nc1-1 rvn nvarca.►►v►va - VL- rMoc L MI -L- rcv SIGNED 71� (/ / C TITLE DATE 11jin r A rf / IVI t IV 11 V J r V N L r �'�• Application Accepted eyf Date Area Employee ID#�� Final Inspection By Date ❑ SPECIAL PERMIT - Approved by Character of Soil to gepth of 3 Ft: Pit/Surrfp Soil Character - COMMENTS PE SG Received Check#/ Amount I Date Permit/Code Invoice # Permit ID# INFO By Cash fternitted Service Request # _ l It c 3 cein I 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/24/12