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W- Z'18 /& - />r <br /> - / ry <br /> 614kY&'WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZEL70N AVENUF-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUN PER�MII-T� , CALL(209)953-76 FOR INSPECTIONS [� EXPIRES <br /> LYEAR <br /> �FROM DATE ISSUED <br /> JOB ADDRESS IDA�rJ bA15✓'—, ,r� IID—_ _-..CITY21P_F��►_✓- --1.��— v. <br /> CROSS STREEETTT -�+—�� �' v_ `- APN -_ —IN _PARCEL SQE <br /> OWNER NAME%�'rL , _... _. L1 t/- UAkn ONt � � •'J, <br /> OWNER ADDRESS — b-lJ <br /> _ CITY/STATEIZIP "`"`��ill 1 95240 <br /> CONTRACTOR - y PHONE 4s-y6- � <br /> CONTRACTOR ADDRESS WA CITY/STATE/ZIP C <br /> LJCENSE 1� C-42 C-36 OTHER NUMBER ,EXPIRATION DATE •IiV __ _ ___ _ <br /> WATER TABLE DEPTH: _ _ft GEOGRAPHICAL INFORMATION: Coordinates X _ Y <br /> C PERC TEST # __._._ BUILDING PERMIT#_!S 0 .�LAND USE APPLICATION# <br /> TYPE OF WORK: X NEW INSTALLATION REPAIR/AI?Dw NI ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT __ _ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: TRESIDENCE COMMERCIAL ^{ OTHER_- <br /> NUMBER OF LIVING UNITS:� NUMBER OF BEDROOMS: J NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG L— _-__ - -._ CAPACITY — gal #OF COMPARTMENTS—9 —_-- <br /> ❑ GREASE TRAP TYPE/MFC _ CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: Wf.LL '25_7 It FourwAl ION it PROPERTY LINE 570C�J- it <br /> ❑ LIFT STATION SIZE TYPE OF PUMP - O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> • <br /> LEACH LINES LEACHING CHAMBERS E - _ #of LINES LENGTH OF LINES ��'�CS(/�� It <br /> DISTANCE TO NEAREST WELL Il FOUNDATION it PROPERTY LINE .J4- It <br /> ❑ FILTER BED WIDTH it LENGTH _ _ It DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATKNI ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH it LENGTH_ ft DEPTH ft <br /> DISTANCE TO NEAREST WELL _it FOUNDATION it PROPERTY LINE ------ It <br /> ❑ SUMPS WIDTH ft LENGTH ,_____ tt DEPTH _ _ It <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION ft PROPERTYLINE__ ._ ... It <br /> Cl DISPOSAL PONDS WIDTH it LENGTH ft DEPTH_ It <br /> DISTANCE TO NEAREST WELL_ ft FOUNDATION -- it PROPERTY LINE ft <br /> YT SEEPAGE PITS NUMBER_ wlDTif __ DEPTH -_----_-_�--` ft <br /> DISTANCE TO NEAREST WELL, ft <br /> FOUNDATION ft PROPERTY LINE ]y ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY. <br /> 4 QIJR 1 Wg RiKQUIRED FOR 1W%P=NSV P1 USE CALL 209 953- 6 7 <br /> SIGNED _ )U(� _ TITLE__ ___---. _ ._-_.. DATE_ <br /> `b' ✓ _, y <br /> -L'A Ile <br /> 4n <br /> qo v — x� <br /> ` x25' (I ` E✓ f,;io -AP, <br /> — —� I�' �` ��v" <br /> I _ <br /> 9 -7 <br /> ' 3 � <br /> (N) (� IImo. o <br /> CE . h O ,�>o.00. <br /> Poo <br /> MoD d <br /> re <br /> • buy <br /> DEPARTMENT USE ONLYE Zwy <br /> Application Accepts _ Date_ ____ Area _� _ �ppae,pry�TdU <br /> Final Inspection Date 'J 0 SPECIAL PERMIT- provedd+Y <br /> P <br /> Character of Soil to pth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> S iROMENT _ <br /> PE SC Received eck#/ Amount Permit! <br /> Invoice# Permit ID# <br /> Code INFO By -1 Remitted Dare Service Request Y — <br /> z ccs 32r 4-6-16 S "a", _-- -- <br /> 4?-0! ONSITE WASTEWATER TRI MINT SYSTEM PERMIT <br /> 412ti 12 <br />