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L 73C <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT { CALL <br /> (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS S«� W fes' I �7 HI 1 17 W - CITYILP L_OD I g52,t(2— <br /> CROSS <br /> CROSS STREET F(--46- �-071 / esI- APN OSS-lGo-78 PARCEL SIZE <br /> 0 <br /> OWNERNAME �(Af�I�'( fALUO(L PHONE <br /> OWNER ADDRESS CbR(nz r1.5 W��L CITY/STATEIZIP Loo)-L C-A <br /> I I <br /> CONTRACTOR WEST CJ nS'fe1 LLCNQ� Ir'f L PHONE V 1 <br /> CONTRACTOR ADDRESS �'� �pTf 33Z CITY/STATE/ZIP VIC-rod <br /> LICENSE ❑C-42 LIC-36 OTHER A NUMBER CJ �« 1 EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 1 I ❑ PERC TEST # BUILDING PERMIT# —040 2-541 LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT L OUT-OF-SE RVICE SEPTIC SYSTEM G DESTRUCTION <br /> I _ <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE Nf COMMERCIAL 1-1 OTHER �I <br /> I NUMBER OF LIVING UNITS: _- C7 NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTICTANK TYPEIMFG �aL N Ltd0 CAPACITY \100 gal #OFCOMPARTMENTS 2 <br /> 1 <br /> ❑ GREASE TRAP TYPUMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE. ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP G PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Q LEACH LINES fl LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Ir FILTER BED WIDTH 73�rL ft LENGTH - (02 G ft DEPTH ft <br /> DISTANCE TO NEAREST WELL I OA ft FOUNDATION ...) ft PROPERTY LINE ft <br /> (3 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Q SUMPS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPFRTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> I DISTANCE TO NEAREST WELL ft FOUNDAT ON ft PROPERTY LINE It <br /> Q SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 1209)953-7697 <br /> SIGNED TITLE 1p(Vn0Dfrl r DATE %%-27.-10k0 <br /> I <br /> X42' �a <br /> r 1 <br /> �4 <br /> 2 P NYIE T <br /> J A04NS VN <br /> _ - - <br /> III ALT DE ARM T <br /> ` +Application Accepted. .Date 11ZZ /O Area Employee ID# <br /> 1 Final Inspection B� C Date 1,W)I X, ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to De hof 3 Ft: PiViump Soil Character: <br /> COMMENTS_a-C'E 1&cbLiGwEi­i� S£T�4�4GZS <br /> PE SC Received Check#/ Amount Date Permit/ Invoico# Permit ID# <br /> Code INFO 8 Remitted Sorvice Request# <br /> Zit, 2s� bZ Sas.tn� !� r SiLoa(o( `tb <br /> 42-01 ONSITE WASTEWATER IHTMNT SYSTEM PERMIT <br /> 9121110 <br /> l <br /> ra <br />