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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)4683420 NON-REFUNDABLE PERMIT CALL 209 9$3-7697 FOR INSPECTION$ EXPIRES 1 YE R FROM DATE ISSUED JOB ADDRESS n1 OfMC(�1T�Y�l/L�P CROSS STREET '✓t F'"�-J �l APN 'V�V PARCEL SIZE -[� QG' c r� ` OWNER NAME �&7 ( 1 PHONE OWNER ADDRESS Y ( CITY/STATE/ZIP CONTRACTOR PHONE CONTRACTOR ADDRESS CITY/STATE/Zip \\ LICENSE IJC-42 QC-36 OTHER NUMBER EXPIRATION DATE J WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: COOrdlnatB3 X Y C PERC TEST # BUILDING PERMIT# D6 LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION - REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE JS C REPLACEMENT ri DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE 11 COMMERCIAL ❑ 0TQ}1/E NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: I .I C>sao S�IMSER OF EMPLOYEES: JLa. SEPTIC TANK TYPE/MFG -I—y-1-5-r N cT CAPACITY 1-2,00 gel #OF COMPARTMENTS Z ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS I DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE ft i ❑ UFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ IL SEPARATO�SED SYS EM) LEACH LINES x LEACHING CHAMBERS X J)1 7(r-7"10'47-oR- #OF LINES L NGTH OF LI ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY L ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMP$ WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH k I DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 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_ 0 Y 5 TITLE f'-6y /J l A 0A0/✓DATE , I N I \ J OIL 3 09 rf p'J1t+ OUN I c� S�ECNI OE4 �µEPn Application— -Accepted — - Data 3 O Area Employee IDN r Final Inspection By - Date D SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: PitlS mp Soil Character: COMMENTS Al EctiJ Lo F C- re�uSE a ! IS IA2 SCiLCND r-rnAda r=oA/ fErK 2 COticljllfivxtc.,rrr --v7Tj rs T c£.as �Zao (; c A/S -- O i l-t>E,BwI CIE, L i- K uV-T fv 6 44"C.a c X11 I�x PE I SC Received Check#/ Amount PermiU Code INFO B Cash Remitted Date Service R uest# Invoice# rrn 49-(41 1(,5±n 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 1014107