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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3YO FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT ,, // C/AL�L(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED JOBADDRESS /]ISD D� 1CASSDILI (2d y CITY/ZIP -1 CROSS STREET - APN 7 ! /l�v -O 7_ PARCEL SIZE y OWNER NAME &I Tl &I ld.a In OWNERADDRESS _ T- CITY/STATE/ZIP / p CONTRACTOR Z•YY�Z4y 19111 T-C PHONE `'(.S� �/O'Go CONTRACTOR ADDRESS��'��o b > ' 2q&,' '4 9 � �_--_ CITY/STATE/ZIP iCj`Y c�rC.)L LICENSE ❑C42 ❑C-36 OTHER - - NUMBS EXPIRATION DATF. -05 0 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X ,^f Y ❑ PERC TEST(S) NUMBER LAND USE APPLICATION# �A -(II s V TYPE OF WORK: 12I NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER _ NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: Ik SEPTICTANKTYPeIMFG — CAPACITY_/ �_ gal #OF COMPARTMENTS ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL .30r-> fl FOUNDATION A PROPERTY LINE to ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) -gk LEACH LINES ❑ LEACHING CHAMBERS #OF LINES�� LENGTH OF LINES 95 , ft DISTANCE TO NEAREST WELL Ron IllFOUNDATION �O t ft PROPERTY LINE R LI FILTER BED WIDTH ft LENGTH 11 DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL Il FOUNDATION ft PROPERTY LINE A ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH fl DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS WIDTH fl LENGTH ft DEPTH It DISTANCE TO NEAREST WELL _fl FOUNDATION ft PROPERTY LINE R 1 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. MIIUM 24 OUR VANCE NOTICE REQUIRED FOR INS CTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE AnIp DATE -- ------ to, Ll . . . .,• 'x: �- �, o. _ .93,44 I ,x '- r-1 !I- � ods — � — - - �-� N 44'4'22c 7 00' 1 ,P+ �P� I vkk CP: �o � DEPARTMEN 1 'EON V 17-- Application Accepted By �/� llate Area Employee ID# —19Y Final Inspection By Date- U� ^D SPECIAL PERMIT-Approved by Character of Soil to th of 3 Ft: - H ump Soil harac[er: / LCL f COMMENTSl'� C7 F-7 Z O �/<9/ 7SceF� /ZD o = coo ~ J PESC Received Amount Date Permit/ Invoice# Permit ID# Code INFO B Cash Remitted Service Re uest# 42-0I-001 -7//r/v 2 / fF'.1 / ONSITE WASTEWATER PERMIT I 2J2102