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t <br /> A/ <br /> aa :;: ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOADUIN COU E IRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUN RM CALL 2 953-7697 FOR INSPECTION E IRES 1 JEA&FROM DATE ISSUED <br /> JOB ADDRESS `' _Cm21P _ _ _ V <br /> CROSS STREET -T,V 1W APN "Q7U� __PARCEL SIZE <br /> OWNER NAM 'RTTgg5 L� NI V_ 1�"I�J)HONE /'� Ea' <br /> OWNER ADDRESS 171-7-57 � � CITY/STATEIZIP�,�' '1924- J <br /> Al- <br /> CONTRACTOR• '(�`,w..`VA QaU%A � _ iN G PHONE _ 16 CM67 <br /> CONTRACTOR ADDRESS _ {/.��,y 4 Wa.Bj_.CITY/STATE/ZIP J <br /> xmiq <br /> LICENSE XI.C-4'2 Ell C-36 OTHER r NUMBER I�,�_EXPIRATIONDATE _ INV <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> fJ PERC TEST # BUILDING PERMIT#_-I-, 4 _LAND USE APPLICATION# <br /> TYPE OF WORK: X NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED JAI <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM _ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE I.; COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: _ NUMBER OF BEDROOMS:.___I -�—"• NUMBER of EMPLOYEES: <br /> SEPTICTANK TYPEIMFG � _ _ CAPACITY gal #OF COMPARTMENTS_. <br /> ❑ GREASETRAP TYPE/MFG _ -__ __ CAPACITY gal #OF COMPARTMENTS-- <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION fl PROPERTY LINE JAL`__.tl <br /> ❑ LIFT STATION SIZE . TYPE OF PUMP___ .-_O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> �[ LEACH LINES X LEACHING CHAMBERS _ #OFLINES 7— LENGTH OF LINES <br /> DISTANCE TO NEAREST WEft FOUNDATION ft [�yf� 1 <br /> ft PROPERTY LINE �(-Jl_!V ft <br /> ❑ FILTER BED WIDTH ____ ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> ❑ MOUNDED WIDTH ft LENGTH _ ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE _ ft <br /> ❑ SUMPS WIDTH _ft LENGTH— ft DEPTH _ _ it <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH —ft LENGTH __.. ft DEPTH_ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION_ ft PROPERTY LINE ft <br /> ` SEEPAGE PITS Nun+BER_ ___(nn_ W�oT1L__ _ �_ DEPTH ft <br /> DISTANCE TO NEAREST WELL_ �J�t�l'.JJ\\+ ft FOUNDATION ft PROPERTYLINE fl <br /> I II EREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M 24 H UV F TIC REQUIRED FOR f PE TIONS- SE CALL(209 53- 6 7 <br /> SIGNFD TITLE DATE <br /> t1 <br /> -6- <br /> 36'A 5' --- tz lv' iti,©/ ��✓ f" <br /> - � t <br /> M06 B <br /> e <br /> (N)BALANCE <br /> j A C <br /> nVjORICiIN POD <br /> PAOD A ` <br /> DEPARTMENtTUSE <br /> � , <br /> Application Accept Date (6411x_— Area �l`L� Emp `D <br /> Finallnspectiott Dale ❑ SPECIAI_PERMIT-Appr5NMbY`-,YC1J <br /> Character of Soil to epth of 3 Ft. ___..._ Pit/Sump Soil Character: /i(K U Z� <br /> COMMENTS SAN JO <br /> MEa NVIROMENTAL <br /> ---- -- LTH e—ahi uiww <br /> PE SC Received heck# Amount Date Permit! Invoice# Permit ID# <br /> Code INFO 8 a Remitted_ Service Request# <br /> 49 A7 illL<-f 06 4 <br /> 4201 ONSITF WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />