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� 1 ONSITE WA 7EWATER TREATMENT SY M PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH''. ARTMENT 600 E%STREET-STOCKTON CA 95202-(209)466420 NON-REFUNDABLE PERMIT 4 CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 1,21 & CITYIZIP hM CROSS STREET - APN LI— C` -µ� C PARCEL SIZE �I-31' o v M OWNER NAME L fr�";i �~C L.Y��'"{ PHONE y OWNER ADDRESS CITYISTATEIZIP CONTRACTOR _fr�J �� -� ' . /�r'- PHONE 1 CONTRACTOR ADDRESS CITYISTATEIZIP r LICENSE 4C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE 6Z'7.L 10 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y © PERC TEST # BUILDING PERMIT# `' U AND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION +� INSTALLATION WILL SERVE: I& RESIDENCE 0 COMMERCIAL ❑ OTHER 1 NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG < CAPACITY— sal #OF COMPARTMENTS { 0 GREASE TRAP TYPE/MFG CAPACITY sal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft 0 LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) L LEACH LINES }& LEACHING CHAMBERS #OF LINES � LENGTH OF LINES ft DISTANCE To NEAREST WELL /S ft FOUNDATION G' ft PROPERTY LINEi ,o ft IV1 0 FILTER BED WIDTH ft LENGTH ft DEPTH ft 9 DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ' 0 MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 77 113 SUMPS WIDTH ft LENGTH ft DEPTH ft r DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I Q DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft f DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft C� SEEPAGE PITS NUMBER I WIDTH " ft DEPTH ft DISTANCE To NEAREST WELL ?�t ,—ft FOUNDATION PROPERTY LINE &f 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. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE DATE ;/A-/,,^' I r_ ` I tv !P° l i ` 'A j V Ra tv TV ^^ T J DEPARTMENT U E LY t Application Accepte Date f Gk Area Employee ID# �` r Final Inspection B � - �,. l'- - Date / r ❑ SPECIAL PERMIT-Approved by Character of Soil to D pth of 3 Ft: Pit/Sump Soil Character: COMMENTS u L.v_a L-.6 j OF }�..(�-.-n PE SC Received Amount Permit/ Code INFO B as emitted Date Service Request# Invoice# Permit!D# 4 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 1 14107