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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1988 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3020 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe AOOREsB _.Z.y�Z� pL p,AL - l <br /> CROSSSWIEET wOQ�SuJ 0.JA __—. APNsp�/OS IioD(=1_ PARCELSQE 2.3 <br /> _ <br /> O'MARNAMEIy <br /> !ti _. �`. _PHONE__...___. <br /> OWNER ADDRESS &Hint. jft� n 1Jlrr ,1 —_Cm/STATEMP _ <br /> OWMACTOR�156�2.1 G_1" `..y I A!(... / /U -PHONE_?�� -S p�)-73q)!jI YAR-Inz- <br /> CONTRACTORADDRESS 1'>'__ OUCH�-_ _�.--_`-_ CMY/STATE/ZIP- WO-1KZ.T->----- �C <br /> LICENSE ,C-42 ,C•36 OTHER Q NUMBER- i(S 7 <br /> U" ��--__ExPIRATION GATE (�(S <br /> WATER TABLE DEPTH: --._......___....---.it GEOGRAPHICAL INFORMATION: Coordinates X <br /> r- PERC TEST M_.. BUILDING PERMIT A _ LAND USE APPLICATION 0 <br /> TYPE OF WORK: NEW INSTALLATION )C, REPAIWADDITK)N ENGINEER DESIGNED TERNATNE f <br /> REPLACEMENT ___ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION __,__ _ r{• <br /> INSTALLATION WILL SERVE: L] RESIDENCE X COMMERCIAL i 1 OTHER 9 <br /> NUMBER OF LIVING UNITS:—___^ NUMBER OF BEDROOMS:_ NUMSEROF EMPLOYEES:__._.__,_ <br /> ❑ SEPTIC TANK TYPEIMFG -_. __. CAPACITY______ _ _ _ gal R OF COMPARTMENTS_ -- -_ -n <br /> ❑ GREASETRAP TYPE/MFG CAPACITY---.----.,-. gal #0FCOMPARTMENTS <br /> Z <br /> DISTANCE TD NEAREST: WELL-__ - it FOUNDATION it PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP-_ ❑ PKG T%PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH UNES � LEACHING CHAMBERS_ (�t' 0OFLINES � `LENGTH OFUNES �'� _ it <br /> DISTANCE TO NEAREST WELL1 _._ <br /> ft FOUNDATION 1J�� ft PROPERTY LINE �� r it <br /> ❑ FILTER BED WIDTH -_ it LENGTH If DEPTH it <br /> DISTANCE TO NEAREST WELL If FOUNDATION ft PROPERTY LINE _— R <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL__ It FOUNDATION -__—it PROPERTY LINE it <br /> O SUMPS WIDTH it LENGTH _ft DEPTH .__--it <br /> DISTANCE TO NEAREST WEU_--- it FOUNDATION it PROPERTY LINE it <br /> 0 DISPOSAL PONDS WIDTH _ ft LENGTH it DEPTH - It <br /> DISTANCE TO NEAREST WELL _1_ It FOUNDATION _ R PROPERTY LINE fl <br /> Q' SEEPAGE PITS NUMBER__- -__! IDT <br /> _._ _-_ WH`.._—sI1� _ _it DEPTH 7-sir it <br /> DISTANCE TO NEAREST WELL 7!� I___._. it FOUNDATION it PROPERTY LINE �J IF it <br /> I riEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDHNANCCS, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPEC77ONS-PLEASE CALL 209 1953-7697 <br /> SIGNED ._.._.�.—__.,.-.--_-- TITLE__. (�S1 DATE_��In.I_�7--ry <br /> --i._ <br /> r9 <br /> _ <br /> IF <br /> O <br /> �Z lli O 1 <br /> - - -�_ � _ a LII <br /> DEPART <br /> Application Acc Date 1 1 Area Q��_i _ Employee IDB G�-� <br /> Final Inspection By_ Date _ U SPECIAL PERMIT-Approved by <br /> Character at Soil to Dj(gth of 3 Ft:_ _ t_ _ PWSUmp Soil Character: <br /> COMMENTS � ` ►� wtKtr SM 4C y`t'\ ',C��F �rIF7 }li2EslLAC�� <br /> -__ 7Crx;rT'r1-LCi#� 2"y AJT�------ <br /> PE SC Received AmOtxlt --- ParmW Invoice 0 Permit IDN <br /> Code two <br /> B aeh RemNbd Service Rea~f <br /> 4Qj 0% <br /> ONSITE WASTEWATER TRTMNT SYSTtM VINMIi <br />