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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 18118 East Hazelton Avenue-STOCKTON CA 95205.6231-(109)488-3420 <br /> NON-REFUNDABLE PERMIT CALL(2091953-7697 FOR INSPECTIONS - EXPIRES 1 YEAR FROM DATE ISSUED G 5 Z� <br /> JOB ADDRESS 2 C11 ZIP_ i ' <br /> CRCSS STREET Q APN Li PARCEL SIZE Y <br /> - o <br /> OWNER NAME d �411Jaz]pi LI LW "E /�- 1l'/I ^ <br /> OY4NER ADOq ESS I �l� W�Y�ell e=KK L.L�CITY/STATFJZIP��`I 'C fC� l Q yGJ�� U, <br /> cn r'I /� <br /> CONTRACTOR 1 A+"1 C�Pf C k h o P Vk!1 V ICY PHONE ao� s AG gag _ <br /> CO:vTRACTOR ADORESe 1 t7�n. I (�� H-�! CITYISTAT!/ZIP Q <br /> , l, I1 rA I) <br /> LICENSE [C•42 �„C•36 OTHER NUMBER-7 - VCJ. xPIRAnoN DATE <br /> WATER TABLE DEPTH: n GEOGRAPHICALINFORMAnON: Coordinates X Y <br /> i� PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# __ <br /> TYPE OF WORK: ^ NEW INSTALLATION REPArRIADDITION I ENGINEER DESIGHEDIALTERNATIVE <br /> REPLACEMENT _] DESTAUCTION t <br /> INSTALLATION WILL SERVE: -7U RESIDENCE CDMMERCIAL <br /> NUMBER OF BEDR1 OTHER V <br /> NUNBER OF LNINC UNRS: I OOMS: NUMBER OF EMPLOYEES: J <br /> ❑ SEPTIC TANK TYPEJMFG CAPACIrY gal #CF COM'AnTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #CF COM-ARTAR_NTS <br /> DISTANCE TO NEAREST: WE-L____ n FOUNDATION fl PROPERTY L NE n <br /> O LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES C LEACHING CHAMBERS ,#OF LINES <br /> LENGTH OF LINES,� ,�/, ft <br /> DISTANCE TO NEAREST 1%F _-LL � FOUNDATION ul/ , R PROFERTY LINE �1-� "1 R <br /> ❑ FILTER BED Wimm it L31GTH n DEPTH R <br /> DISTANCE TO NEAREST WELL•_ It FOUNDATION R PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH It LEMG-,i h DEPnI_ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LI KE ft <br /> ❑ SUMPS WrJ:H ft LENGTH n DEPTH <br /> DISTANCE TO NEAREST WLLL_ __ _ n FOLNDATICN R PROPERTY LIKE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH A n DEPTH ft <br /> DISTANCE TO N ST WELL ft FOLNDA71C.4 n PROPERTY LINE R <br /> SEEPAGE PITS NoMoeR WIDTH U.- D;P'H , <br /> DISTANCE TO NEAREST WEtL---�•'iOUNWTIONA' PROPERTY LINE 'Tit <br /> 1:EREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STT/F <br /> ND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> 1 4 O NO �CEOUI FOR INSPECT S- LEASE CL(209)953-7697SIGNED 7 TITLE <br /> I <br /> I <br /> I I II tI <br /> I ri <br /> r <br /> ! rn X <br /> -- - - m <br /> I rr gD-t � m <br /> y <br /> MPS �3 <br /> ti 10►,�^W,G1a^P'�v DEPARTMEN SE NLY ( (� <br /> Appliutbn Accepted _ Date 1 Area Employee I \V <br /> Final inspection ey Data` ❑ SP ALP RMIT•Approved b <br /> Character of Soil to pol of 3 FL Porymp Soil Character: <br /> COM ENTS <br /> PE SC Recelved Check#/ Amount Date Penn' Invoice# Peftn(tID# <br /> Coda INFO 8 ah Remitted Service Re nest# <br /> }ILL / - <X1Ir Cab <br /> 42{1 00i-2—i 7 ONSITE WASTEWATER TRTMNT SYSTEM PERMR <br /> i U"7 <br /> °d,?zZ`7 <br />