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JOB ADDRESS I I OCC . cirazip VIA Ps f•-ritCA q S-33 (p
<br />CROSS STREET 1::>C1's L- APN 2-24-- 0 3o -2-(e PARCEL SIZE ID Ac
<br />OWNER NAME 124‘4 L nn: 4A- W2t Eft- PHONE .2- 3 - I -?•CI
<br />OWNER ADDRESS 2-7- 0 E • yosaK rm A " V cn-asTATErzip enA-ArrEcel-, qS-33(o
<br />CONTRACTOR E 6E0 EN\J I (2-0/JeilE ArrA PHONE 362?-
<br />CONTRACTOR ADDRESS LiC) (4) -C Pçjc. ST • CITY/STATE/ZIP ctS-7-4-10
<br />LICENSE EIC-42 EIC-36 OTHER
<br />
<br />NUMBER EXPIRATION DATE
<br />
<br />PERC TEST #
<br />TYPE OF WORK:
<br />BUILDING PERMIT # LAND USE APPLICATION #
<br />REPAIR/ADDITION 0 ENGINEER DESIGNED /ALTERNATIVE NEW INSTALLATION
<br />INSTALLATION WILL SERVE: 0 RESIDENCE 0 COMMERCIAL 0 OTHER
<br />
<br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES:
<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 (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED
<br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X
<br />REPLACEMENT
<br /> 0 DESTRUCTION
<br />SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS
<br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTmENTS
<br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft
<br />LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM)
<br />CI LEACH LINES 0 LEACHING CHAMBERS # OF LINES LENGTH OF LINES PA
<br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE Rt MEN?.
<br />FILTER BED WIDTH ft LENGTH ft DEPTH
<br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE
<br />0 MOUNDED WIDTH ft LENGTH ft DEPTH 1114 )Iftc
<br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 4 2019
<br />a" SUMPS WIDTH ft LENGTH ft DEPTH JOAO
<br />EAW, 00v-m, DISTANCE TO NEAREST VVEU. ft FOUNDATION ft PROPERTY LINE ilcALri4"i' DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH
<br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 7-meNT
<br />SEEPAGE PITS NUMBER WIDTH ft DEPTH ft
<br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft
<br />Employee I Dti_c2:Lk_...L.,
<br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION 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 />UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697
<br />TITLE CATN St/ 1.-Tet DATE Cv- " I 41 SIGNED
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<br />Application Accepted By
<br /> DEPARTMENT Date / /U S YO Area 3 f.q,
<br />Final Inspection By Date U SPECIAL PERMIT -Approved by
<br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character
<br />COMMENTS
<br />PE
<br />Code
<br />SC
<br />INFO
<br />Received
<br />13x ,
<br />C-C-heccle Amount
<br />Remitted Date Permit/
<br />Service Request # Invoice # Permit ID# s
<br />kr 2 5-z3 ati--- 1711L..2._. f 5 7— c3-11-1-101
<br />42-01
<br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT
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