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Y i ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE-3"e FL-STOCKTON CA 95202-(209)46$-3420 NON-REPUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE EssuED JOB ADDRESS J, CITV/ZIP q CROSS STREET /�GG! 3I n APN � PARCEL$[ZE�� a OWNER NAME x• 42// v "f PHONEi OWNER ADDRESS / CITYISTAT7i/21P CONTRACTOR PHONE CONTRACTOR ADDRESS CTrV/STAT£TLIP LICENSE C•42 ❑C-36 OTHER NUMBER E:CPIRATIpN DATE WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X ❑ PERC TEST 8Y ELILDINC PERMIT# LAND USE APPLICATION TYPE Op WORK: NEW INSTALLATION ❑ REPAIRtADDrriomV�+ ❑ REPLACEMENT d ENGINEER DESIGNED/ALTERNATIVE CI DESTRUCTION INST �y ALLATION WILL SERVE: yo REsIuENcE {3 COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OP EMPLOYEES: ❑ SEPTICTANK TYPFJMFG CAPACITY, r gel A OF COMPARTMENTS ❑ CREASE TRAP TYPPJMFp CAPACITY n n $81 #OPCOMPARTMENT$ v! t ❑ PKGTXPLANT DISTANCETONEAREST: WELL� r ft FOWDArroN ft PROPERTY LINE_ !S ft ❑ LIFT STATION SIZE TYpE OP PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTRM) J ❑ LEACH LINES P LEACHING CHAMBERS # �j.� ,r+ I OF LMES_w�� LENGTH OF LINES—,CJ{„/ T ft{ D[STANCRTONEARFS'1' WELL 419-1'/ R FOUNDATION /0 fl PROPERTY LINEfi ❑ FILTER BED WIDTH ft LLE-NNOO-YH`µ---- R R DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ❑ MOUNDED WIDTH ft LENGTH R ft DEPTH R DISTANCETONEAREST• WELL ft FOUNDATION ft PROPERTY LINE ❑ SUMPS WIDTH_ 40 R LENGTH Fr ft •- ft DEerH DISTANCE TO NEAIREST WELL 151P ft FOUNDATION I 13 DISPOSAL PONDS WIT TH ! �--R PROPERTY LINE it ft LENGTH R DEPTH PISTANCE Tp NEAREST WELLR R FOUNDATION R` PROPERTY LINE C1 SEEPAGE PITS NuMeCq WIDTH ! it DErrH ` DISTANCE TO NEAREST WELL ft R FOUNDATION [ ft PROPERTY LME—R I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICA77ON AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY Irr ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(2091 953-7697 SIGNED TITLE � "- DATE i 1 ZOO a IN C V DEPARTMENT SvON Y Application Accepted B Dale Area Employee ID# Fina!ctepection By Date -.tel• CharackrvfsoB to h vf3 Ft: ❑ SPECLIL PERMIT-ApplDYed by [! PlYSBmp Soil Character: COMMENTS PE SC Received heck#/ Amount Code INFO B as Remltted Dao Permit) lavvicelM Service R Dest# - Permit ID## b D 'kw Z 43-02.001 121221200; ONSITE WASTEWATER PERMIT