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I ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT GOO E MAIN STREET-STOCKTON CA 95202-(249)4611-5420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS `-� IrYIZEP p t I CROSS 5TRLET APN O [ LDPARCEL SIZE,.,,- r 6 114 OWNER NAME �7 I PHONE -p(6 d .... � O&NER ADORES, -v' CITYISTATEIZIP /.� f _- vr? 9 y�,— i n i CONTRACTOR Ot^ b C_ E v' L4- /�b PfiONE - Ir CONTRACTOR ADORESS I CITYISTATEIZIP LLs LcEmsr QC-42 FC-36 OTHER- NUMBER VS Z EXPIRATION DATE - Y0 WAtER TABLE DEP714: R GEOGRAPHICAL INFORMATION: Coordinates X Y ,I FERC TESTit BUILDING PERMIT# LAND USE APPLICATION#_77 I TYPE OF WORK: it NEW INSTALLATION JK�-REPAIRIADDITION ❑ ENGINEER DESIGNED IALTERNATIV- f7 REPLACEMENT ❑ OUT-OF SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: D RESI4ENCE -- COMIaeRcuL L DTHER NurAHrR OF LIVING UNITS: NUMRFR OF BEDROOMS: NUMBER OF EMPLOYEFg 2-40 J 0 /l t SEPTIC TANK TYPEIMFG i.❑r1 (',APACITl' gal #OF COMPARTMENTS _ 1 Q GREASE TRAP TYPFIMFG e1 RAPACITY gal At OF COMPARTMENTS - DISTANCE TO NEAREST: WELL IPJ Q 'F It FOIINOATION ft PROPERTY LINE fl I ❑ LIFTSTATION S1ZE TYPE OF PUMP ❑ PKG TX PLANT U SAND OIL SEPARATOR I ENCLOSED SYSTEM) EI ❑ LEACH LINES ❑ LF-ACHING CHAMBERS I Nor LINCs � LENGTH OF LINES p 1t f DISTANCE TO NEAREST WELL JQ a *it FOLNOATION /(�. _ry FROPERTY 11N1- ❑ FILTER BED WIDTH ft LENGTH ft DEPTH f! DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPCRTY LINE __ ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNOATION ft PROPERTY LINE Ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ({ DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fc l ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH it DISTANCE TO NEAREST WELL FOUNDATION ft PROPERTY ONE N SEEPAGEPtTS NUMBER dnWIDTH " ft DEPTH pl T h DIS{ANCE TO NEAAt:ST WELL_ D„{� ft FOUN.)ATION 1,.Z? ft PROPERTY LINE �[j p -} _it I I+EREBY GERTI FY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. STATE LAWS ANO RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. M1N1M0M24H6JVJP.ADVA CE NOTICE REQUIRED FOR INSPECTIONS-PL ASE CALL 209 953-7697 ;. SIGNED TITLE � A: QL- DATE_, F , - - m� i w 5 � :.. _..._........ .. - w ' F-41 - ' N 52 _ C 'AF- P. y. 1-4- i s _ , D-EPi9M.E"N -...�._...:. x ��_.-_�:. _ -�' '__`--•_- y- AppVcatlon Accc Date Area Vj y FmPloyse I041 Final Inspection B Dale %9 .�_ l_` SPECIAL PERMIT•Approved by_ Character of Soil to apth of 3 Ft: PIt1 ump Soil Character; COMMENTS PE Sc Received Amount Permit Date Code__ INFO B Cash Remitted Service Raguest fl Invoice N Permit IDTI � t7Z Z// 42-C1 ONSITL WASTEWATER TRT&INT SYSTLM Pi-RMI T s+zula