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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED Joe ADDRESS J` , ^ ! C CITY21P / e CROSS STREET ! 7 I I�_Y�G`�/ APN �^ (.'I PARCEL SIZE 7A / l ^ OWNER NAME �l(:SC l) /�•%��v PHONE Gr- ' i OWNER ADDRESS CITY/STATE(ZIP CONTRACTOR PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ' C-42 I 1 C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: I ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION plc REPAIR/ADDITION ENGINEER DESIGNED/A TERNATIVE 1 '1 REPLACEMENT /_ OUT-OF-SERVICE SEPTIC SYSTEM X DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL I I OTHER NUMBER OF LIVING UNITS: NUMBER pOFBE/DROOMS: NUMBER OF EMPLOYEES: gIL SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS /❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS - DISTANCE TO NEAREST: WELL EV bI lL I�ft FOUND" I C7 It PROPERTY LINE Z ft ❑ LIFT STATION SIZE TYPE-OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS p #OF LINES LENGTH OF LINES 0 R DISTANCE TO NEAREST WELL ham/r 'R FOUNDATION ~ eft PROPERTY LINE �/ ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE (i ❑ SUMPS WIDTH ft LENGTH It DEPTH It DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH R DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It I HEREBY CERTIFY THAT I 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)953-7697 SIGNED TITLE i / I ��LLc '? TITLE ^r•�'/�c r'� DATE /.;�i�:-•i/ C , , Alt- ` I f - - ; I . I i Applicadon Accepted B Date Area Emplgl�'�Q Final Inspection By Date I SPECIAL PERMIT-Appy 11pr'*tr-1VE Character of Soil to Depth of 3 t Sump Soil Character: t�� COMMENTS I AW / / ft e1 o a'rl LL /saG tN CO�U.c� w 1�/ IS (l`l 'T.:N,1 ✓n S .�� M fc�'i .RO PE SC Received eck#/ Amo nt Permit/ r Code INFO By Cash Remitted Date Service Re uest# Invoke# Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4124112