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"—A.^ 'i )" ONSITE WASTEWATER TREATMENT SYSTEM PERMIT /V00 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468.3420 NON-REFUNDABLE PERMIT CALL(209)9;2-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED Joe ADDREss //� 79 CrTYfZ-P J f7 to CRDSS STREET S /'V(// t/�L/ • APN 2 r a �D� PP"ARCCEL?SME .O OWNER NAME LI.n�.JC A' /i( 'L16�'f, �../�PH�ONE 1�`0,9) k'3-9-7leS-7 OWNER ADPREaS 3 S"a 7 14) , �l ��i• CITY/STATFIZIP �]-1.44(r( � C�GC♦ CONTRACTOR '/ [�I.(,Q• aAL12 S , PHONE I CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑C42 OC-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# _ n?l M WORY,! L NEw INSTALLATION 0 REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE O REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: U RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: O SEPTIC TANK TYPElMFG CAPACr7Y 981 MOF COMPARTMENTS O GREASE TRAP TYPE/MFG CAPAWTY gal #OFCOMPARTMENTS____ DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE R O LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) O LEACH LINES G LEACHING CHAMBERS tt OF LINES LENGTH OF LINES —ft DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE_ R O FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R ' O MOUNDED WIvrN ft LENGTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION _. it PROPERTY LINE R O SUMP$ w1orH ft LENGTH ft DEPTH_ ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYUI ft O DISPOSAL PONDS WIDTH_ _ ft LENGTH_ ft DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION _ _ It PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DLPTH ft DISTANCE TO NEAREST WELL _ __R FOUNDATION ft_ PROPERTY UNE ft 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 }� SIGNED L ` yr TITLE 1Wjt1[STA_ DATE I � } t I I , I 4AI R Id Y nr � " PAl�Th11�IST E O Y-�' //�JJff��Jjjl�� Application Accepted Date Area Employee ID# Final Inspection By Date U SPECIAL PERMIT-Approved by / Character of Soil to Depth of 3 Ft: <✓ Pit/Sump Soil Character: COMMENTS_�� c 7`kY:1 �� j31�+ 11 �`? �l�l� l7Tl�t / lY�� Zlez PE SC Received Check#! Amount Permit/ode INFO B Remitted Date Service uest p Invoice# Permit lD# 2 8b2Two s 4201 ^� � ONSITE WA TEWATER If S lEj