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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 6 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM 7DATE ISSUED JOB ADDRESS ,. CITYZP 7 1/ �ll�.y\ �( ✓1, CROSS STREET �O� APN J'/6D'`4 `Py! / ry� ) PARCEL SIZE qA-C OWNER NAME •StT �lj�LGvN I I"i C' PHONE `1 ZS- LSO- SS/O 7 OWNER ADDRESS/ 1 P' �' J d/� L�� CITY/STATEMP CAPITOL A Gtr CONTRACTOR �^'t�E �D^A�TIL- EO E�.�JV IKW►'►1��T�L- PHONE Z-ocl - 3(act-c 3):l (- u CONTRACTOR ADDRESS OAK- STCITY/STATFJZIP L ( (-II1 I LICENSE C-42 C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y ?` PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIRiADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL it FOUNDATION ft PROPERTY LINE It ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #CF LINES LENGTH OF LINES R DISTANCE TO NEAREST WELL R FOUNDATION fl PROPERTY LINE ft ❑ FILTER BED MOTH ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH it LENGTH ft DEPTH ft j DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE To NEAREST WELL it FOUNDATION it PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH fl LENGTH It DEPTH ft DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE fl ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH it DISTANCE To NEAREST WELL it FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 1 M R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 q /� SIGNED TITLE C-C►�1ftJ LT�R7�-i'r DATE i01, RO Ul N C40 k OU TyCEpgRTT9 N)y MRNT PARTMENT USE ONLY /� Application Accepted By G Date j Z. "1 Area, Employee ID# Final Inspection By Date 1 .SPECIAL PERMIT-Approved by Character of Soil � to Depgth of 3 Ft: IPit/Sump Soil Character: COMMENTS�Q(t�i L? r <hC: > L+1J0.;li' S�1I uri�zr UI�1f'ti F�►�YI� fD t� PE SC Received Chac Amount Data Permit] Invoice# Permit IDN Code INFO B Remitted Service RequesLO 47-01 nNCITF WACTPWATFR TRTLANT CYCTFM PFRMIT