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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDA13LE PERMIT CALL 209 953-7897 FOR INSPECTIONS EXPIRES 7 YEAR FROM DATE ISSUED <br /> Joe ADDRESS J 1 D l Swi p+v CIn1LP Y/ �f �1 5's a <br /> CROSS STREET ( APN SS'� O O PARCELSIZE <br /> OWNER NAME `- �QQ�7�'!�T �'S �y^PHONE <br /> OWNERADDRESQS��,�^l .✓D 1 S(�yl{'" De.'! M «-�,{_.(A,y7 /J+` CRYISTATFJLP/�)� t <br /> CONTRACTOR•�`�`�^+�e�^7 6 �t i�I-AA MQA!il '( PHONE �t{�� {LIQ `P <br /> CONTRACTOR ADDRESS S3 [ S17 A..d �I�-(�� CRYISTATUhP <br /> gD2 ExPIRAnoN DATE <br /> LICENSE DDC-02. D❑C-36 OTHur— ? NUMBER , <br /> WATER TABLE DEP6: 40 f � R GEOGRAPHICAL INFORMATION: Coordinates X Y - 1 <br /> PERC TEST BUILDING PERMIT# LAND USE APPLICATION lIt <br /> :TYPE OF WORK: U NEW INSTALLATION - U REPAIRIADDITION U ENG{N£ERDESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑. OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UMTS: NUMBER OF BEDROOMS: NUMBEROFFMPLOYEES: <br /> ❑ SEPTICTANK TYPE(MFG CAPACITY gal #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE <br /> CAPACITY gal <br /> OOFCoMPnnrMErrrs <br /> DISTANCETONEAREST: WELL ft FOUNDATION ft PROPERTYLINE R _# <br /> ❑ LI FT STATION SIZE TYPE OF PUMP LI PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES (I LEACHING CHAMBERS #OF LINES LENGTH OF LINES R 3 <br /> DISTANCE TO NEAREST WELL - R FOUNDATION ft PROPERTY LINE it _ <br /> ❑ FILTER BED WIDTH ft LENGTH It DEATH fi <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE R <br /> ❑ MOUNDED WmTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft LENGTH R DEPTH <br /> DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY UNE <br /> ❑ DISPOSALPONDS WIDTH ft LENGTH ft DEPTH f, <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft - ) <br /> -❑ SEEPAGEPITS NuMBER WIDTH It DE-PTH It 't <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY UNE R 1 <br /> TION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICAj <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE RE UIRED FOR INSPECTIONS-PLEASE CALL(209)n953-7697 <br /> SIGNED TITLE, ♦ /�q i DATE <br /> i� <br /> l <br /> 1 O d <br /> au 0 I <br /> U 1t (I <br /> pEPARTME US ON� <br /> Application Accepted By Date t Area 3 rL� Employee IDR <br /> Fina11n3p8CV0n By Date _ ❑ ;SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft - PiUSump So11 Character. I <br /> COMMENTS t <br /> i <br /> PE SC Received Ch Amount Date a Re Invoice R Permit IDR <br /> I <br /> Code INFO 8 Cas Romlttod Service Ra uost lY .I <br /> f�5 X125 i 3u 3 -V /7 low <br /> - <br /> a42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4124112 <br />