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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COU EIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AvI:NUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUN FERMI CALL 2 953-7697 FOR INSPECTIONS7 E IRE!1 EA FROM DATE ISSUED <br /> JOB ADDRESS _. CITY/ZIP {.,J�_—..-.._.�_ f <br /> CROSS STREET 'ry .L__ APN Q1' {,1.�1yN�—.,� PARCEL SIZE. S, . p <br /> OWNER NAM'�kas1�Jr <br /> in 1LUTJ A � �v_ u -HONE —49-7_0/O <br /> OWNER ADDRESS Q � `— T <br /> CONTRACTOR PHONE 466 - <br /> 07 <br /> CONTRACTOR ADDRESS w, CITY/STATE/ZIP370(=t9 <br /> LICENSE ) C42 ❑1 IC-36 OTHER NUMBER tOO5 1.1 .EXPIRATION DATE M / <br /> WATER TABLE DEPTH: it GEOGRAPHICAL 114FORMATION::� Co—ordinates X Y <br /> ❑ PERC TEST S BUILDING PERMIT#— LAND USE APPLICATION if _ <br /> .— --- — <br /> TYPE OF WORK: NEW INSTALLATION REPMR/ADDITION ENGINEER DESIoNEDIALTERIIATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE I; COMMEnCIAL �j( 1 1 OTHER <br /> NUMBER OF LIVING UNITS:_11 � ^/ -NUMBER OF BEDROOMS: __ _ 500} NUMBER OF EMPLOYEES: _ <br /> SEPTIC TANK TYPE/MFG ���''''�)�� 1.10 _— _- CAPACITY _ gal #OF COMPARTMENTS_2— <br /> ❑ GREASE TRAP TYPE/MFG { CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TG NEAREST: WELL _ Y- it FOUNDATION 5 it PROPERTYLINE 500+n <br /> II <br /> ❑ LIFT STATION SIZE -_ ----TYPE OF PUMP __O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> �( LEACH LINES X LEACHING CHAMBERS_ �4 __ #OF LINES LENGTH OF LINES `ate' z it <br /> DISTANCE TO NEAREST WELL 1-�J'� it FOUNDATION it PROPERTY UNE �I.JC_/7 0 <br /> ❑ FILTER BED WIDTH _ it LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE it <br /> ❑ MOUNDED WIDTH it LENGTH ---- it DEPTH it <br /> DISTANCE TO NEAREST WELL _.. it FOUNDATION it PROPERTY LINE it <br /> ❑ SUMPS WIDTH _it LENGTH___-_ it DEPTH it <br /> DISTANCE TO NEAREST WELL _ _- it FOUNDATION it PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH __ It LENGTH_. ____ it DEPTH_ it <br /> DISTANCE TO NEAREST WELL _ it FOUNDATION it PROPERTY UNE it <br /> SEEPAGE PITS NUMBER 9- W D _ n DEPTH it <br /> DISTANCE TO NEAREST WELL _it FOUNDATIONRTY LINE_ MCC.1w it <br /> I I-IEREBY 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 SAID JOAQUIN COUNTY. <br /> M 24 LQU VQ;0jQtT/Qk REQUIRED FOR f PE ONS-rJAASE CALL 209 53- 6 7� <br /> SIGNED TITLE DATE <br /> � —40 AOS/ <br /> � I r <br /> £ (N)BAUNCr_ I p eq �q00• H <br /> h T avJ •b \ J <br /> A 'NOD C '1' <br /> - MOD A •S 1Nj 1 POD <br /> �j2EP�ARTXFE.NT` 'E�ONLY / AY1�1 � <br /> Application Accept _ Date -''�-�,"� Area 04{/ <br /> `L trn <br /> p� � � <br /> Final Inspection Dale._ �i�/�. _ SPECIAL PERMIT-Apprgppd,by <br /> Character of Soil to <br /> �� e�plh of 33 Ft: _— Pit/Sump Soil Character: h1r1( (J 2Q <br /> COMMENTS 61 c Lc_ l Q�[� ---------- SAN NOR ru.... _ <br /> ---------- MEIY1' <br /> PE SC Received heck# Amount Permit/ <br /> Code INFO BY s Remitted_ Date Service Request N invoice$ Permit ID# <br /> 4k;; ALT- <br /> 42-01 <br /> 742-U1 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />