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�. ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 93202-(2D9)46&3420 <br /> NON-REFUNDABLE PERMIT <br /> CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS SOO �-- Vii.fT�� d CrrY21P S7�,c41,,Y/ 932/S b y <br /> CROSS STREET .nf��C�1C/T�S APN 105-044-I S PAARCELS¢E <br /> OWNER NAME PHONE <br /> OWNER ADDRESS CITYISTATF/ZIP <br /> CONTRACTOR1<1 <br /> './ , !A /-iJii " c- PHONE <br /> CONTRACTOR ADDRESS CITYISTATEIZIP <br /> LN%NSE AC-42 LrC36T OTHER NUMBER���%�J� EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 9 <br /> ❑ PERC TEST # BUILDING PERMIT - O LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ DI ENGINEER DESIGNED IALTEANATIVE <br /> ❑ REPLACEMENT Ll OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: C RESIDENCE 2k< COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG 141Y/— CAPACITY7,6fJ gal It OF COMPARTMENTS + <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS 1 <br /> i <br /> i <br /> DISTANCE TO NEAREST: WELL 1'9�9 R FOUNDATION /D� ft PROPERTY LINE 5-'} ft <br /> 4� <br /> LIFT STATION SIZE TYPE OF PUMP Z +� PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSE j�SYS <br /> A6 LEACH LINES LEACHING CHAMBERS #OF LINES �_ LENGTH OF LINES �O' dS ft <br /> DISTANCE TO NEAREST WELL Zj-;W.)r-f It FOUNDATION i-D/l' It PROPERTY UNE { ft <br /> (3FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Q MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> R DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE 1I1' ft <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH 7 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH_ ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE I ft <br /> ¢r SEEPAGE PITS NUMBER WIDTH ft DEPTH -�� 9 ft <br /> DISTANCE TO NEAREST WELL �C"YJ'rt ft FOUNDATION 0 4) _ft PROPERTYLINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> t STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. e <br /> MINI M 24 HOU ADV NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-716997 <br /> — TITLE C DATE/�L��` <br /> SIGNED <br /> I <br /> / f 0 <br /> 6 � <br /> E Ti <br /> I <br /> a 4 <br /> JO kQU1 C LN. <br /> ON A <br /> N T 0 R <br /> E..ART­MF.N T ,S_ O J-Y _ ,_rte_L <br /> Appllcatlon.Accepted By Date Area Employee ID# <br /> ❑ SPECIAL PERMIT•Approved Dy 9 Flrq-'t lnsp'ec4lon ,-J � ,;,._ `M Date 0 <br /> Character of Soil to pth of 3 Ft: PiU u p Soil Character: <br /> COMMENTS « � '4 <br /> 1 <br /> ( ry 3L�n n <br /> PE SC Received ChecidN Amount DatePermlU Invoice X Permit ID# <br /> ( Coda . INFO B Remitted Service Request# ' <br /> I <br /> ONSITE WASTEWATER TRTMNTISYSTEM PERMIT <br /> 420t <br /> tU1l0109! . <br />