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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1668 E. HAZELTON AVENUE -STOCKTON CA 95205 -(209) 468.3420 NON-REFUNDABLE PER CALL 20,.9) 9,513-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS "1 ] M I C Jam. 9100- I. CITY/ZIP L OcUq S Z Q CROSS STREET Qt\} MkLk ROO.A APN i PARCEL SIZE a OWNER NAME 0001i& C we n S PHONE OWNER ADDRESS tt 101 Oa G r'O-V'P– &00,A —CITY/STATE/ZIP Lock_; C (I S 2- Li Q CONTRACTOR J CO'S A'YV-C ti 0"1 PHONE C'"Lo) LA �I� – 2 L( - q CONTRACTOR ADDRESS P i] V `/ n (G I`'r CITY/STATE/ZIP E IK GrOJe. c4A /,I S -7 S 1 LICENSE VC -42 I- C-36 OTHER NUMBER '112 43b EXPIRATION DATE WATER TABLE DEPTH: PERC TEST # TYPE OF WORK: J201-710 ft GEOGRAPHICAL INFORMATION: Coordinates X Y ' I BUILDING PERMIT # LAND USE APPLICATION # / NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALT R TIVE Y REPLACEMENT 0.n K OUT-OOFSEPTIC SYSTEM DESTRUOTION INSTALLATION WILL SERVE: L RESIDENCE COMMERCIAL _ OTHER 1 I NUMBER OF LIVING UNITS: NUMBER OFBE_D1ROO NUMBER OF EMPLOYEES: Gj SEPTIC TANK TYPE/MFG in i , rGLT l^ Ir– �1 Y APACITY S C) gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLAINT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH It LENGTH 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 ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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. SIGNED jL \�-I•N'-' TITLE Pi QSAe-f-1-lC DATE ART EN L Application Accepted By Date Area Employee ID#� Final Inspection By Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Degqth of 3 Pit/ mp Soil aracter: COMMENTS 2 DiC� K PShr0�1 e iYl ONA tt l)(),w SP - c. PE Sc Received Check#/ Amount a Permit/ Invoice # Permit ID# Code INFO Cash Re ittService Request # rtlltyC � - 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114118