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ONSITE WASTEWATER TREATMENT SYSTEM PERMITi <br /> SAN JCAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95245-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECT/OM3 EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS./,�y_I...:45.J1-..._.S�.w t-....25 � CITY/Zlp 1��1IQ _�..__.._....L. -4­� y <br /> CROSS STREET ..,. . YAPN <br /> o <br /> PARCEL SIZE <br /> OWNER NAME_ PNONE <br /> OWNER ADDRESS .._..,.._............. .....A'�R. �.—CITY)STAT'at .._t_`_�.�..�°kJ � 1S ✓G <br /> CONTRACTORy, b r ~ HONE Y` "63 �!t-"l !i'"v+•-1 <br /> CONTRACTOR ADDRESS <br /> .,-r_ <br /> LICENSE ❑:.IC-42 [11 C-36 OTN£R....._.................__..__..._.._.........._..... NUk9ERr4' - _EXPIRATION DATE._.___.. <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X_......__........_...._.___...._................... Y_.........................__......_....__...,..,._ <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT ............. OUT-OF-SERVICE SEPTIC SYSTEM X DESTRUCTION <br /> INSTALLATION WILL SERVE: ' RESIDENCE ':.! COMMERCIAL C: OTHER____.___ <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS:.__,.-.,,_- NUMBER OF EMPLOYEES:- -� <br /> SEPTIC TANK TYPE./MFG "L- CAPACtTY '•�, _., gal #OF COMPARTMENTS...._,.._.,,__7.;,____„_ <br /> ❑ GREASE TRAP TYPE/MFG _...._,,,,,_ — CAPACITY- gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL -LLrLl a:...ft FOUNDATION '�” I ft PROPERTY LINE�� 1 `ft <br /> ❑ LIFT STATION SIZE ------TYPE OF PUMP___ 13 PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS-_,,,,__„-__-,,___,__­-.--_,-.,__ #OF LINES__r_- LENGTH OF LINES ­-_,it <br /> DISTANCE TO NEAREST WELL - ft FOUNDATION ft PROPERTY LINE ft <br /> FILTER BED` WIDTH �� \ ft LENGTH Ste' 'YG I ft DEPTHft <br /> 7 2-,- DISTANCE TO NEAREST WELL-, I KnTTTF-----OU___NDAI'KRJ '�/ i n PROPEFTTY LINE 4 n <br /> �1 Inr jb <br /> ❑ MOUNU d WIDTH_.,.__....... n LEND _ /_ _...__ _It DEPTH _ __.__... 1t <br /> DISTANCE TO NEAREST WELL_ _ it FOUNDATIONft PROPERTY LINE--.------.ft <br /> ❑ SUMPS WIDTH-...__.........._......... —ft LENGTH ft DEPTH _ it <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY UNE _it <br /> ❑ DISPOSAL PONDS WIDTH—_-_ ft LENGTH. ft DEPTH_ it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION .....__._._ft PROPERTY LINE,----._,_ <br /> ❑ SEEPAGE PITS NUMBER _,__ __.__�,-...,_ WIDTH- �- _y-ft DEPTH _.ft <br /> DISTANCE TO NEAREST WELL „-ft FOUNDATION ft PROPERTY LINE—— <br /> 1 HEREBY CERTIFY THAT 1 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 SAN JOAQUIN COUNTY. <br /> MINIMUM 24 IJOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 20 953-769 <br /> SIGNED....---. --.._-.___Y. .........................................................--_--.._______— TITLE__ DA of <br /> 1 7 <br /> i `A <br /> lit <br /> n — a <br /> sr_a _JL <br /> Application Accepted BDaate Area___-.,-_ employee ID#Final Inspection By u SPE IAL PERMIT-Approved byCharacter of Soil to D th o}3 Ft:,,_ (12=Soii Character: _ <br /> COMMENTS ('� - J 14/14.1C_T_��G -F� J._ny}L <br /> a 8 rr <br /> PE SC awed Check#/ Amount PermIV I <br /> Code INFO 8 Cash Remitted Date Service Request# Invoice# Permit IDk <br /> 2 7.� <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br /> 4f� <br />