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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT UO E MAIN STREET-STOCKTON CA 85242-(209)4883420 <br /> NON-II�GiUN4 N• CALL 9 953-7697 FOR hySPECTIONS <br /> DD _ 1 YEAR FROM PATE ISSUED <br /> 1W0"", <br /> ARESS --- Cr YIZIP } <br /> 8555TREET APN - <br /> PHONE <br /> PARCEL SIZE c <br /> NER NAMCITYISTATEIXJoe <br /> ADDRESS I <br /> • FC PHONE <br /> CONTRACTOR <br /> CfTYlSTAYEIZiP <br /> CONTRACTOR ADDRESS yy <br /> � Y� <br /> LICENSE W-42 :�C-36 OTHER NUMBER��•EXPIRATION DATE <br /> WATER TABLE DEPTH: �I`-,,., L fi GEOGRAPHICAL INFORMAY70N: Co'Dronal4S X Y <br /> C1 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> : NEw INSTALLATION <br /> REPAIRIADORKNI ENGINEER DESIGNED IALTERNATiVE <br /> TYPE OF WORK <br /> REPLACEMENT ❑ OUY•OF$ERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: a RESIDENCE � COMMERCIAL C! OTHER <br /> NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> LNUMBER OF LP/ING UNITS: - <br /> O Mk <br /> SEPTIC TANK TYPEFG j r 1 CAPACITY 981 #OF COMPARTMENTS <br /> • GREASE TRAP TYPEMIFG CAPACITY gal #OF COMPARTMENTS - <br /> DISTANCE TO NEAREST: WELL It FOvNOATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE 7D NEAREST WELL ft F0UNDATION_-1A0*-(1 PROPERTY LENS <br /> L3 FILTER BED WWTH R LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOONOATION, It PROPERTY LINE ft <br /> MOUNDED WIft DEPTH RDTx h LENGTH k <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE <br /> ft DEPTH ft <br /> ❑ SUMPS WIDTH ft LENGTH <br /> DISTANCE TO NEAREST MLL ft FOUNDATION it PROPERTY LINE ft <br /> ❑ DiSPOSALPONOS WIDTH fl LENGTH It DEPTH fl <br /> DISTANCE TO NEARSS T WELL ft FOUNDATION ft PROPERTY LINEft ^n <br /> SEEPAGE PITS NUMBER DEPTH e ft ft <br /> DISTANCE To NEAREST WELL fl FOUNDATION„,• t---_ fl PROPERTY LINT <br /> I HEREBY CERTIFY THAT I HAVE PREPARED T45 APPLICATION ANDA REGULATIONS OF HEDOME <br /> O COUNTY.IN ACCORDANCE <br /> WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LA <br /> 1 4 N TICS RE UlREf3 FOR - LEASE CALL 209 53-76 <br /> SIGNS TiTL DATE <br /> e.:J Iii <br /> L'.] <br /> L I <br /> LI. <br /> DEP.An.rME T <br /> •-:� �,-� = _ Date .... _ Area Employee <br /> Application Accepts Date �_f [I SPECIAL PERMIT-Approv0kA/ _ <br /> Final Inspection BY - r- <br /> Character DI Soil to of 3 Pt: PWSump Sdi Character:_ <br /> COMMENTS 'L 4 r ! JU - 12 <br /> _— _-- SAN JQAQU'N;r-A-Tv <br /> ' �'��ItOfrMCI <br /> PE SC Reaelred I C Amount Date PennW tnvoiee• Perm <br /> Code INFO Cash Servkte Re uastN <br /> ! l <br /> 5:: ��4 1 2Wr 745 Y •2-50 c 1WASTEWATER TRIMNT SYSTEM PERMIT <br /> 42.0t <br /> 9/21/10 <br />