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~ It,= Z �,. iia "T= v. _,f f Wsri `E I/AS TEWATER TREATMENT SYSTEM PERMIT SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTGN AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUN A PERMIT CALL(209)953-769,7 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS -,y�_ CITYIZIP �Fq -��'/ CROSS STREET CA T [.�_— — APN, _. Q��/U PARCEL SIZE I I p ,/yam�SP�tO OWNER NAME , �� _ _`uj�i N OWNER ADDRESS _-FFT _—__-_CITY/STATE21P 601IU�►/A�� J2� CONTRACTOR j )- - E ��yt� PHONE___ I;- J�,J 7 CONTRACTOR ADDRESS -i- Yv1__?1___--_._CITY/STATEIZIP 11AA LICENSE '� C-42 ' C-36 OTHER__-.._ NUMBER_-w5wEXPIRATION DATE__•1 L� l WATER TABLE DEPTH: N GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST a I—BUILDING PERMIT#_ S _LAND USE APPLICATION# -� TYPE OF WORK: NEW INSTALLATION REPAIR/Ailmw N ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: Rt RESIDENCE t! COMMERCIAL •^{ 1 OTHER_ NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: —_ J NUMBER OF EMPLOYEES: SEPTICTANK TYPE/MFG—! kL------- _.._ CAPACITY� — gal #OFCOMPARTMENTS_�____, ❑ GREASE TRAP TYPE/MFG __ CAPACITY gal #OF COMPARTMENTS-- DISTANCE OMPARTMENTS —DISTANCE TO NEAREST: WELL Al.5±.. it FOUNDAh NJ it PROPERTY LINE SOS it ❑ LIFT STATION SIZE _ TYPE OF PUMP __ 0 PKGTXPLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) �d LEACH LINES LEACHINGCHAM13ERS 670 2A _ #OF LINES LENGTH OF LINEcS40- it DISTANCE To NEAREST WELL +_ it FOUNDATION_ Or it PROPERTY LINE_ f5Cr4_. it ❑ FILTER BED WIDTH it LENGTH _ _ it DEPTH_ it DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE it ❑ MOUNDED WIDTH _ it LENGTH--_— -- —it DEPTH __.. it DISTANCE To NEAREST WELL -it FOUNDATION it PROPERTY LINE It Cl SUMPS WIDTH _it LENGTH _ K DEPTH _ _ it DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE _ It ❑ DISPOSAL PONDS WIDTH __. _ —it LENGTH _ --- it DEPTH_ _ It DISTANCE To NEAREST WELL _ it FOUNDATION - R PROPERTY LINE____ N 16 SEEPAGE PITS NUMBER- 3 WID H _ h DEPTH — _Z it DISTANCE TO NEAREST WELL_ it FOUNDATION_- N PROPERTY LINE R I 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 REGULATIOtIS OF SAN JOAOUIN COUNTY. �\/N��N,{� 4 HO R T R QUiRF-D FOR 1 NS SE CALL 209 953-Z697 SIGNED ( _ TITLE__C&VDATE __ t3 �► tj � AO' J VIV \.l (M}C �POD MOD:'>. _�ialt Pc.luo DEPARTMENT USE ONLY YME10T_ Application Accepte ' - — Date qj__.-_ _ Area _D _ Final Inspection 1P-- - - Date S CF7"------ -- F. SPECIAL PERMIT-A proved by Character of Soil to Pth of 3 Ft: Pit/Sump Soil Character:__. _ fpp tie ._ COMMENTS S NV1gOMENTAL PE SC Received eck#/ Amount Dace Permit/ Invoice# Permit ID# Code _ INFO By Remitted Service Request# .. _ Aza (« X32 4q-r, 4-6-16 9N7H516 _- 42.01 ONSITE WASTEWATER TRI MNT SYSTEM PERMIT 4/24/12