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ONSITE WASTEWATER TREATMENT SYSTEM NPERMIT <br /> UE-STOCKTON CAsssos-(7o13)468-:�4210 <br /> SAN JOAOUM COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> NON-REFUNDABLE PERMIT CALL 2U9 933-7697 FOR INSPECT70NS EXPIRES 1 YEAR FROM DATE ISSUED <br /> M J <br /> CInRIP <br /> Jae ADDRESS rr��J/l lt1 Jou 4`� <br /> 1> <br /> APN J7;�S� L PARCEL SIZE <br /> CROSS STREET PHONE •:'�'/I�- /_�C' Z <br /> OWNER NAME._.,jLL�•�s�... /s�G��3 sc.r r�.. <br /> CI7Y15TATEIZiP <br /> OWNER ADDRESS <br /> PHONE 9"�L�Z� I � ✓ /L S ! <br /> CONTRACTOR I <br /> CITYISTATETUP <br /> CONTRACTOR ADDRESS _ lIC >��5..»^✓ l 7 <br /> UCENS£ i42 i. C-36 OTHER NUMBER IJ'jlj EXPIRATION DATE 9 r <br /> WATER TABLE DEPTH: <br /> ftGEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST tl BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATIONpe <br /> R£PAIafADDITiON ENGINEER DESIGNED(ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: "„>�RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF EMPLOYEES:—_____J <br /> NUMBER OF LIVING UNITS NUMBER OF BEO'ROOMS .3 <br /> L CAPACITY 991 #OF COMPARTMENTS <br /> CI SEPTIC TANK TYPENFG ''��'� CAPACITY gal #OF COMPARTMENTS <br /> D GREASE TRAP TYPEiMFG <br /> R <br /> DISTANCE TO NEAREST: WELL R FOUNDATION tl PROPERTY LINE <br /> U LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT U SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES �._ _ LENGTH OF LINES ��✓ It <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION 'Vi ft PROPERTY LINE ft <br /> ❑ FILTER SED Nhon+ It LENGTH it DEPTH It <br /> h <br /> DISTANCE TO NEAREST YJEU h FOUNDATION h PROPERTY LINE <br /> ❑ MOUNDED WIDTH it LENGTH it DEPTH ft <br /> DISTANCE TO NEAREST WEUl ft FOUNDATION h PROPERTY LINE- <br /> 13 <br /> INE CI SUMPS WIoTN it LENGTH ft DEPTH —ft <br /> DISTANCE TO NEAREST WELL h FOUNDATION h PROPERTY LINE ft <br /> h DEPTH R <br /> O DISPOSAL PONDS MOTH ft LENGTH <br /> .,t it PROPERTY LINE <br /> DISTANCE TO NEAREST WELL It FOUNDATION <br /> h <br /> ,p SEEPAGE PITS NUMBER I WIDTH 1� ft DEPTH 5- ft <br /> I ft <br /> DISTANCE TO NEAREST WELL /50 h FOUNDATION ft PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE 11 PREPARED TF#.SAI WORK-VOLL B DONE N ACCORDANCE <br /> COUNTY. U TH SAN JOAQIN COUNTY ORDINANCES, <br /> STATE� RULES AND <br /> A##INI M 28 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED 71TLE GATE <br /> I <br /> 15 <br /> ' U <br /> P A R 7 M EN T y <br /> �� '1�Application Acc Date � Area Employee 1D#�,� <br /> Final inspection By _ ` Data is SPECIAL PERMIT-Approved by <br /> Character Of SOLI to De th of 3 Ft: PttlSump Soil Character: <br /> COMMENTS nA Le, <br /> PE SC Received Amount .__ invoice# Permit 1!J# <br /> COde INFO B Date <br /> Remitted` Service Roquest 4 <br /> 9 <br /> i <br /> I <br /> ONSITE WASTEWATER T'RTMNT SYSTEM PERMIT <br /> 82-DI <br /> 4/24112 <br />