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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JoAcium Courm ENVIRON10ENTAL HEAL TH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 96208-1(209)468-3420 NON-REFUNDABLE PERMIT CALL hVSPECnONS EXPIRES I YEAR FROM DATE ISSUED ——-—------------------------------- JOE ADDRESS CrrYrzIP ....... CROSSSTREET _ZkAPN-,,4,/ PARCEL S12E > OWNER NAME 4 A.A664xi------- ---------- OWNER ADDRESS Cl"ISTATEOP .......... ............... CONTRACTOR, av, ... ............PHONE CONTRACTOR ADDRESS /............ . ........... CITYiS1 ATE/ZIP <"!?...........!�'� UcENsE OTHER Y J._ NUMBER- ........EXPIRATION DATE.......... ................ WATER TABLE DEPTH:... ......... ft GroGnAPHICALINrORMATIOW Coordinates X Y ...................... .. PERC TEST It BUILDING PERMIT LAND USE APPLICATION ......................................... ......................................... .................................. .................... TYPE(5F WORK: NEW INSTALLATION REPAIRIAowtoN ENGmrfADtswNev1ALrEnNATw REPLACEMENT ......................... OUT-OF-SERVICE SEPTIC SYSTEM 1__1))FSTAUCTtON ..................................- INSTALLATION WILL SERVE: -<RESIDENCE COMMERCIAL OTHER ............... LNUAdRER_Ot I-Nm UNITS, NUMBER Qf NUMBER OF EMPLOYEES. — Q SEPTIC TAMC TyPtIMFG --------------_------- CAPACITY ......................... gal #OF C0MPARTMENtS,______.._ 0 GREASE TRAP TYPfYMyG ............................................. CAPACJTY...................................___ gal #OF COMPARTMENTS.-_____ DISTANCE 70 NEAREST, WFA1. it FO)I�OATION......... h PROPERTY LINE.......... 0 LIFT STATION SIZE ......... .................TYPE OF PUMP.............._............... LI PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS ,�V.LiNt's 1.F rJGTH OF LINES ft ...................... .......... DISTANCE TO NEAREST WELL it PROPLA'rY LINE Ll FILTER BED WIDTH it ISNO,rH it DISTANCE TO NEAREST WELL fl FOUNDATION ...........ff PROPERTY it 0 MOUNDED WwTti __.............. —It LENGTH DFPTH it DISTANCE TO NEAREST WELL ft KAINDATION it it Q SUMPS WIDTH itLENGTH ft DEPTH ft 01'STANCE TO NEAREST WELL__._ it FOUNDATION it PROPERTY LINE it DISPOSAL PONDS WIDTH 4.................ft LENGTH___........... ........ it DEPTH .......it DISTANCE TO NEAREST it FouwA:noN ..............it PROPERTY LINE._._.._..____.. It Cl SEEPAGE PITS NuMeEn..................... -------� WIDTH-—------- ..___,...__,....-.-_.____..,,..........__.__._,ft it DISTANCE TO NEAREST WELL...................... it FOUWATION it PROPERTY IJNr.......... it I iEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, C� I STATE LAWS AND RULES AND REGULATIONS OF SAN JOA0UJN COUNTY. UJNIMUQ FOR INSPECTIONS--PLEASE CALL 94- SIGNED TITLE, DATE -`C/^•'..... ...... .......... .............. ........... ........................................ A 4-M -7 At Ty .................. ................ I T-- ONk-f Application Accep Employee Area ............... fig....._.. Dat SPECIAL PERMIT-Appmved by oil C Final Inspection 4 ............ Character of Son 10 3 Ft: P"Ymp Soil C aracter: .......... .................. COMMENTS e-. .4_1 51 22*71i 'e2kAt' 416 ................................................................................. ............ PE SC Received fiec Amount Data Permit/ Code IMPO ash Remitted Service Re 1�t 0 Invoice It I Permit 10# 'zoo i.� ............. .......... —_-_............................... 42-01 ONSITE WAS rEWATEA 1TlTMNT SYSTEM PERMIT 412,4112