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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET•STOCKTON CA 95202-(209)468,420 <br /> NoN-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADoREse Z Cm/LIP <br /> ' E4ST S r O.CROasSTEEr APN Of3 -2t0_p� PARCEL Sae is. <br /> OWNER NAMt' -Fi�n10E.Q.S FC+J/�-NCt A-t_ G">Q.-Vt{7� L-t-_C PHONE <br /> lip <br /> OWNER ADDRESS �,tiPO 4 O`C 1-747/ f CrNtSTATE(ZIP )L-f 0,0E--U`0 CA Q�3 S3 <br /> CONTRACTOR j 0 41 A1,0[,0 _l i��J';'�G 4' �J7��/(/' PHONE <br /> CONTRACTOR ADDRESS =ly-{ rt��I/'N!/�W.A/- I CITY/STATE21P <br /> LICENSE nC12 QC-36 OTHER 1' NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 0 PERC TEST N BUILDING PERMIT* LAND USE APPLICATION III <br /> TYPE-OF WORK: 1, NEW INSTALLATION 0 REPAIR/AOomoN it ENamEER DESIGNED/ALTEIWATNE <br /> li W REPLACEMENT 0 OUVOF-SERVICE SEPTIC SYSTEM 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE 0 COMMERCIAL L OTHER <br /> NUMBER of LNING UNITS: NUMBER of SEDRoOMs: NUMBER of EMPLOYEES: <br /> la SEPTIC TANK TYPE/MFG -5-C✓C C CAPACITY 0 pal #OF COMPARTMENTS 7_ <br /> ❑ GREASETRAP TYPE/MFG CAPACITY pal #OF COMPARTMENTS <br /> 1` DISTANCE TO NEAREST: WELL Sam ft FOUNDATION ft PROPERTY LINE fl <br /> r.x <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) W <br /> ❑ LEACHLINES0 LEACHING CHAMBERS #OF LINES LENGTHOFLNEs ft <br /> DISTANCE.TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ FILTER BED WOTH It LENGTH ft DEPTH ft TFI <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED Worth ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL h FOUNDATION R PROPERTY LINE R <br /> IL SUMPS WIDTH 1-4 IT LENGTH 'Z t=j ft DEPTH 9 f <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH SC• R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY UNE R Q <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DRsTANCE TO NEAREST WELL ft FOUNOATION ft PROPERTY LINE R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> j I STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMU <HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED TITLE J DATE <br /> I ? <br /> c I <br /> i-, <br /> trrntNT <br /> I <br /> �t..._.�,-:�y'�__ _» �.--,—D.EP.AR7.MENZ SE.� N1-.Y,�.-...•-.•.._-- <br /> I Appltcedon Acca ed By - Date Area Employee ID# C� <br /> Final Inspection Date /� f��(SPECIAL PERMIT- ved Dy <br /> Character of Soil to Depth of 3 t: Pwsump Sal Character. <br /> COMMENTS 0" a-0-f-0 �.tE�p2� C�.EctR4t GE,QX(T P I+✓� , 6�45_�il�Z rC,00 J I ft L r rs <br /> PE SC Received Checka4 Amount Oate Permlru Invoice <br /> N Permit IDN <br /> Cods iNPO B as Remitted Service Request X <br /> 212- 115" I ) o 5g--- 1 <br /> 42�-01'S ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> c::f:i <br />