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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET - STOCKTON CA 95202.(209) 4693420 NON-REFUNDABLE P�� ERcMt IT L L:ALL EZUH) SOS-IIIIV7 FOR INSPECTIONS MPIRES TGTEAR FROM LIATE ISSUE1 JOB Ammmas CD Z. [ I _ qi a n"_ _ L A . CITYMP C A- f CROSS STREET C r APN Fl,�r I31- 0,6 _ PARCEL SZE III -#- A- OWNER NAME �jn y.l'•'�.F_cC 1 l�Pf iJ jy}ijL �" �"r �� ONE�a� OWNER ADO mss lD1 S F - LTGr J&g CrrYISTATEMP L7SA•1 CA- -l� LC"I C• CONTRACTOR PHONE CONTRACTOR ADDRESS CrrYISTATE17 P LICENSE OC -42 ❑C-30 OTHER NUMBER ExPIRATKIN DATE WATER TABLE DEPTH: --K GEOGRAPHKAI.INFORMATION. Coordinates X Y J PERC TEST # I F—BuILDINGPERmrr#.ZQ'—bd--ftZ�"f/'4:;LAND USE APPLICATION 31 Application Aete Date Final Inspection B Data Character of Sall to pth of 8 Ft: COMMENTS /Y.D 1,lsi Coda 42-01 10!4107 Date . REPLACEMENT DESTRUCTION LMSTALLAT10N WILL SERVE: RESIDENCE ❑ COMMERCIAL Try ❑ OTHER NUMBER OF LNING UNITS: NUMBEROFSEDROOMS: J NUMBEROFEMPLOYEES: O SEPTIC TANK TYPEIMFG _ CAPACITY gat f# OF COMPARTMENTS C11 GREASE TRAP TYPEIMFG CAPACITY qal 00FCOMPARTMENTS DISTANCETONEARE&T: WELL ft FOUNDATION _ R PROPERTYLINE R E] LIFT STATION SIZE TYPE OF PUMP Q PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM} LEACH LINES LEACHING CHAMBERS -7 #0FLINES LENGTHOFUNIm -7< R i, DISTANCE TO NEAREST W91 fYy FOUNDATION It + ft PROPERTY LINE S + ^ft E3 FILTEReED WIDTH R LENGTH ft DEPTH ft DISTANCETONEARESY WELL ft FOUNDATION ft PROPERTY UNE ft O MOUNDED WIDTH A LENGTH ft DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It SUMPS WIDTH !A ft LENGTH_ I�j R DEpM 51 ft DISTANCE TO NEAREST WELL - 5 FOUNCATION t O * ft PROPERTY LINE f ft C1 DISPOSAL PONDS WIDTH It LENGTH _ R DEPTH fl DISTANOEToNEAREST WELL ft FOUNDATION fl PROPERTYLINE It O SEEPAGE PITS NUMBER WIDTH _ fl DEPTH ft DISTANCE TO NEAREST WELL ft -OUNDATION R PROPERTY LINE ft l 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. MIN111111.7 R ADVANCE NOTICE REQUIRED FOR INSPECTION -PLEASE' CALL (WS) 857.7611IT SIGNED __ __J /!i J1i�._� _ _ TITLE I DATE Application Aete Date Final Inspection B Data Character of Sall to pth of 8 Ft: COMMENTS /Y.D 1,lsi Coda 42-01 10!4107 Date