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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 6GO E MAIN STREET-STOCKTON CA 95202-(209)468.3420 NON-REFUNDARI.E PERMIT l CALL(2 Si 853-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED Joe ADDRESS-`7j 1F f�j �,,f12y rTY/ZIP._�14�5 I CLGMF S cao.a,:T�« iI3�.R-ry APNL�. rt `r OWNER NAME P�v L-t- r I`-�-D CLa�S �•PHONE �� OWNER ADDRESS P&OL- 2k49�i JN-C-►L `rDnlE CTTYMTATEIZIP _G L-"T; GIA CONTRACTOR_._LA\) O^V-. G-IE,DENViKONN'tENTfC II PHONE 34q-o37:1�-�L tl CONTRACTOR ADDRESS � y � CDY/STATFJLIP L.Oa), CA ��Z�•Fo GCENSE r.1C-42 I-iC•36 OTHER NUMBER EXPHUtTioN DATE WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# - TYPE OF WORK: J3 NEW INSTALLATION iJ REPAIRIADOITION u ENGINEER DESIGNED/ALTERNATIVE C REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: - RESIDENCE LI COMMERCIAL L OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY�)( gal #OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG CAPACITY I Oal #nF TinMPAR'rmPNTR DISTANCE TO NEAREST: WELL ft FOUNDATION it PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES 7, LEACHING CHAMBERS #OF LINES LENGTH OF LINES It DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH it LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH R LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it ❑ SUMPS WIDTH ft LENGTH it DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH it LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft f DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE it I HEREBY CERTIFY THAT 1 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. t.:r`i"eGtits�2 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-76S7 LL SIGNED TrrLE GDNS✓L•'T�w T DATE - t � `""'T Inti YIN if1•J:y u� mss" r I I ENT 1 t ) I V E D 2 6 2014 3 WUIN COUNTY _ ROMENTAL _ DEPARTMENT DE ARTMEKTUS a ONLY Application Accepted By Date Area I'4 A. �1 r) Employee ID# Final Inspection By Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Receivedh� Amount Permit/ Invoice# Permit ID# Code INFO B/ Cash Remitted Pate Service Request# f(� n i �- / J r` I I 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 10/4/07