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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-MO <br /> NON-REFUNDABLE PERMIT CALL 12 3-769TFOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> NN ZZ t Ca1ll clTYrzIP <br /> JOB ADDRESS <br /> i <br /> SS STREET_ ,�"APN �/7D/ PARCEL 31ZE <br /> ER NAMEG4111J IPHONE <br /> ER ADDRESS,JAwIC. 2 FW CS'iY(STATE/ZIP p <br /> CONTRACTOR 1AjI t C-DISI DAg-K ft a -` PHONE �Z7�� � <br /> CONTRACTOR ADDRESS�3 EYx 312 �1C� � ��Z+S3 CITY/STATEZP 1�_ <br /> LICENSE [aC-42 C1C-M OTHER HUMBERSSLIS / EXPIRATION DATE 74:512 n <br /> G <br /> WATER TABLE DEPTH: <br /> ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> fli <br /> ❑ PERC TEST # ^] BUILDING PERMIT# LAND USE APPLICATION# Ja <br /> TYPE OF WORK: ❑ NEW INSTALLATION CIREPAIR/ADDITION ❑ ENGINEER DESIGNED(ALTERNATIVE „p <br /> Se REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: Z / NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG 5-410.^Sa:'P'�i L CAPACITY �S�J 981 #OF COMPARTMENTS Z <br /> ❑ GREASE TRAP TYPElMFG CAPACITY gal #OF COMPARTMENTS <br /> D{STANCE TO NEAREST. WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> (3LEACH LINES, LEACHING CHAMBERS I N�l+i�ACJ( #OF LINES 2- LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> it FILTER BED. WIDTH it LENGTH it DEPTH It <br /> DISTANCE TO'NEAREST ,WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O MOUNDED WIDTH it LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST .WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SuIll?. ,.I,'; lDTH. ft LENGTH ft DEPTH ft <br /> � 7t,i &WANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE <br /> �'�jtift <br /> �� ft DEPTH R <br /> O DISPOSAL PbNDS':'(IYIDTH ft LENGTH ` <br /> • J '� -T„ DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE NU —ft <br /> 6i PITS';;', MBER WIDTH Z ft DEPTH ZS ft <br /> SEEPAGE <br /> DISTANCE TO NEAREST WELL ICQ• ft FOUNDATION �i ft PROPERTY LINE <br /> i HEREBY CERTIFY THAT HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM Z4 HOUR ADVANC ZIGEREQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697p(� <br /> SIGNED '� �' TITLEESN'I DATEy- 2 Z <br /> I <br /> l <br /> 1 <br /> p r — <br /> lit 2.111, <br /> I:- <br /> l <br /> DEP T'll E N T-AYSE OIN LY <br /> "�re -...-..Em I- ID# <br /> ApplicationAccep � Data 5 D Area Po1�- -0--�•.-. <br /> Final Inspection Date � 7 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to th of 3 Ft: PItlSump Soil Character- <br /> COM <br /> haracter: <br /> i COMMENTS D -- <br /> J <br /> • PE SC Received Check#/ Amount PIU Invoice# Permit ID# <br /> Code INFO E4 Cash Remitted Date Service Request# <br /> Z y oa 5'/'3//0 '59 <br /> t 42-01ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 6126/09 <br />