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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4684420 NON-REFUNDABLE PER IT CALL 209 953-7697F R INSP_EC77ONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS ......._ ........... ...._... .._---.._ _ RYRtP /�' ! C —'------- �-�--- GV"r CROSS STREET .._.___.........._ _ .................. APN_�•Jj..t,)�•t� -PARCEL SIZE....* _�._g__ O y }�,� tl OWNER NAM �C1V� PHONE. "' --- ......_ .._.. OWNER ADDRESS �._ __..._ ._.__.._.._._..._. Sn'S'r L/�_�f✓___ ___.._CITVJSTATEJZIP=. ..............1._......._ _._..__J./_. CONTRACTOR - __. _ ,�i ©1 .. ..............4_�1...........(r.-�t'y...�............. PHONE. CONTRACTOR ADDRESS �L,J N •,—�1�i-50 .,,-.........�J�..!) ._,_I,,.___....CITY/STATEIZIP _l.( .�+!?9�!!'.____.T�_ LICENSE )( C-42 ;...i C-36 OTHERNUMBER.1..001.57-_.....EXPIRATION DATE_..__.At.�_t_y._ WATER TABLE DEPTH:. ,,,,_,. it GEOGRAPHICAL INFORMATIO Coordii►n._at�es X 777 Y (.) PERC TEST # BUILDING PERMiT# � f —"-ND USE APPLICATION# _. TYPE OF WORK: NEW INSTALLATION R PAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION _ INSTALLATION WILL SERVE: X RESIDENCE El COMMERCIAL Ll OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: — p SEPTIC TANK TYPE/MFG _,_„ _.._.�,�,.__....__—__...___.—.___ CAPACITY—,.1.600— gal #OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG__ ,,,,-„__-, CAPACITY_ _._...._ gal #OF COMPARTMENTS -...... DISTANCE TO NEAREST: WELL C)* ft FOUNDATION__.........._S_ ft PROPERTY LINE _—_-5 it ❑ LIFT STATION SIZE TYPE OF PUMP _O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES ')I LEACHING CHAMBERS #OF LINES_,__ LENGTH OFLINES it �,r DISTANCE TO NEAREST r�A,�WELL_ _'r........_.. it FOUNDATION_, ft PROPERTY LINE j�it yY FILTER BED NhDTH Oft ft LENGTH....._.................... 14 ft DEPTH it DISTANCE TO NEAREST WELL — it FOUNDATION it PROPERTY UNE� it ❑ MOUNDED WIDTH it LENGTH ft DEPTH it DISTANCE TO NEAREST WELL it FOUNDATION—it PROPERTY LINE it ❑ SUMPS WIDTH it LENGTH ft DEPTH it DISTANCE TO NEAREST WELL it FOUNDATION .ft PROPERTY UNE--�-----h ❑ DISPOSAL PONDS WIDTH__-,,,, it LENGTH ft DEPTH__ __.M Y �y it DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE 1 _.ft ❑ SEEPAGE PITS NUMBER-------,_� WIDTN_ ft DEPTH_ it DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN A WITH AN JOAOUIN COUNTY ORDINANCES,STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY S CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN L WORKERS COMPEN+5 ION LAWS. SENT M 9thicU OTICE REQUIRED FOR 1 !ON -PLEASE CAL( 209 Q(x� SIGNE ___..... . .._ ._... _.. _ _...._.._. TITLE ._ DATE_� .- _....._.._�_Y Application Accepted By...... _ G:FYI. ...� _ Area �....t....d.. ..... Employee 10#C t!'^.-'Z_..__. Final Inspection By_ Date- SPECIAL PERMIT-Approved by Character of Soil to De of r_.. _—.......___ Pit/Sump Soil Character: COMMENTS PE Sc Received Amount Date Permit/ Permit# Permit ID# Code INFO ash Remi Service Request# to 6j � 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 515+17