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t8P oa-o a3�t ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE•3"FL-STOCKTONCA 95202-(209)46"20 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED //,,��t'01 1-1,A , _�e �} /�•�-� � JOB ADDRESS LY L L 4 t p R CITYIZIP /•F�'t'T f" ✓ 4- 4 3 36 L ? CROSS STREET IiO7'T4'SL- _ _ APN D-).S PARCEL SIZE e OWNER NAME 0C!� r a e\1,!2( PHONE. OWN'ERADDRESS J CA/\ L 1a / CITY/STATEIZIP_ CONTRACTOR _ yYl I ILL] is �LIC)�1�nve- l r• ��TPHHONF. �Gb�� CONTRACTOR ADDRESS IQ(, to�,V Cll'YISTATEIZIP /Y 1 P-1+-e-C f 4-L75-M;L LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE 6�201 , WATER TABLE DEPTH: �11 i ft GEOGRAPHICAL INFORMATION' Coordinates X Y ❑ PERC TEST(S) NLMBER LAND USE APPLICATION# TYPE OF WORK: Qf NEW INSTALLATION C3 REPAIR/ADDITION ❑ ENCINF.F.R DS_SICNFWALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: JJ RESIDENCE ❑ COMMERCIAL ❑ OTHER_ NUMBER OF LIVING UNITS: 1 NUMBER OF HEDROO.NS: t N UMBER Of EMPLOYEES: (►Y SEPTIC TANK P'v@IMFG _ _. CAPACITY Q._,(SQ........... "_ gal :i OF COMPAR'i'ME\TS ;` ❑ GREASETRAP TYPE/MFGCAPACITY gal #OF COMPARTMENTS ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ZOO It FOLNDATION" U R PROPERTY LINE [5 It ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) If" LEACH LINES ❑ LEACHING CHAMBERS 9 O LINES _ LENGTH OF LINES &A DISTANCE TO NEA REST WELL Ion, ri FOUNDATION �O 1_tt PROPERTY LINE El FILTER BED WIDTH fl LescrH fT DEPTH ft DISTANCE TO NEAREST WELL_ f1 FOUNDn'ION It PROPERTY I.[NE ft ❑ MOUNDED WIDTH R LENGTH ft DEPTH it DISTANCE TO NEAREST WEL I. ft FOGNDATION_ ft PROPFRTY L[NG $ SUMPS WIDTH a' fi LENGTH i 1(01 ft DEPTH )CSI it DISTANCE TO NEAREST WELL 1110i -ft FOUNDATION, I C)l ft PROPERTY LINE SO it ❑ DISPOSAL PONDS WIDTH it LENGTHfl DEPTH it DISTANCE TO NEAREST WELL. � ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS WIDTH R LENGTH ft DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION 8 PROPERTY LINE it I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.769; SIGNED 6�� _ TITLE� In'!{-r4 c-�rJ'r DATE 1 60 03" L 0 9•/ } 1 1 I p �i I Vi SAI U I - i r J AOJIN NTe 14-1-] Lli DEPARTMENT SE O'LY Application Accepted P�.y Date i Area Employee ID#_ _ Final Inspection By/ /fi �- Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Fr. Pit/Sump Soil Character: COMMENTS AIAW Xo PE SC Received Chccbt AmountDate Invoice p Permit IlTit Codi INFO B ash Remitted ce . ( to D S XLI/J-3 42.01-001 I2fL'O' ONSITE WASTEWATER PERMIT