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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS rr2 ` CmuZIP CROSS STREET APN 01-3 2-Co-0 PARCEL SIZE O• DD D d -C PHONE OWNER NAME (..4C�wJD �r rJ�NG[ILL C�-✓Qf/ItT ___ `G. OWNER ADDRESS �^y10C 6 0)C 1-747 ' CITY/STATE/LP I'-(OA E-STO C�4 Q53S3 CONTRACTOR / I.00le-// _ _1 l�dT G P �1��✓C/' PHONE ��J /� 5..��Ir CONTRACTOR ADDRESS �//N!/r -C�.�r/. CITY/STATERIP--"0?,' /� )j T'f-j` LICENSE 1--C-42 CSC-36 OTHER NUMBER //3-NS'�t EXPIRATION DATE 41 / i' a7/ WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATKIN: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: F NEW INSTALLATION ❑ REPAIRIADDITION n ENGINEER DESIGNED/ALTERNATIVE Ii Ii' REPLACEMENT ❑ OUT-0F-SERVICE SEPTIC SYSTEM & DESTRUCTKIN O L+J INSTALLATION WILL SERVE: 7 RESIDENCE ❑ COMMERCIAL L OTHER NUMBER OF LNING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: H SEPTIC TANK TYPE/MFG C-''C C CAPACITY Z gal #OF COMPARTMENT 2 ❑ GREASE TRAP TYPE/MFG_— - CAPACITY gal #OF COMPARTMENT I` DISTANCE TO NEAREST: WELL 9-0 ft FOUNDATION ft PROPERTY LINE ft 13 LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACHLINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES w ^ ft O I I DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 11 1 ❑ FILTER'BED WIDTH ft LENGTH ft DEPTH ft m DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE R ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft I DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft IL SUMPS WIDTH C_/It LENGTH --L l--f ft DEPTH -e ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE k 'y I r� ❑ DISPOSALPONDS WDTH .SJ ft LENGTH ft DEPTH ft DISTANCE TD NEAREST WELL It FOUNDATION ft PROPERTY UNE ft 1�) ❑ SEEPAGE PITS NUMOER WIDTH ft DEPTH ft 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. MINIMU 4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE e�'j ^- DATE Ef T un>- D v r' ours NNT lit I 1.:_'- �D ERA RT.M.EN.T S.E.. N_Ly_-a^ � �_ �• -- T q� 1 �ApplicationAc ed B - Date �S Area Employee ID# `r�L( Final Inspection Date /f�� SPECIAL PERMIT-A roved by Character of Solt to Depth of 3 t: PiUSump Soil C rider. COMMENTS O c o [-0-7-o f 4Cco -9Lc4 A-L Q ('T "f0,e D JC-A , '4,4,S IE.O 0,110 � C®NSu 'ZOJ SI. DOS-9-74-1 (ft 7- M r4 G(G 4&-1C- r 7-.S PE SC Received Checldtf Amount Date rm Peit/ Invoice# Permit[DO Code INFO B as Remitted Service Request# �2ra 1(S I Zoe Dl's o.c-I) ) o 429 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT '