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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 NON-REFUNDABLE PERMIT /CALL 2,09 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS G Ly i J v �y CITY/ZIP ty1 2 L �'t 7 CROSS STREET /6/� `� �/.',{_A�, (, `1 `�n� �) �AAPNN "8�S�o •J PARCEL SIZE �' s•IJy^ '/ rel OWNER NAME �f"�dN�1.+i`�(J �YP/�yu/}P/�-+�j��f(J�`� PHONE OWNER ADDRESS �5 D20- P/x"z- \ 17L CITY/STATEIZIP CONTRACTOR Central Valley Demolition Inc PHONE 209-450-8432 CONTRACTOR ADDRESS 3928 Crocus Drive CITYISTATE/ZIP Modesto,CA 95356 LICENSE ❑ C-42 ❑ IC-36 OTHER C-21 NUMBER 901159 EXPIRATION DATE -07MV20'r k �iI WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED/A ERNAVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION (? C^' INSTALLATION WILL SERVE: ❑ RESIDENCE n COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASETRAP TYPEIMFG CAPACITY gal #OFCONIPARTMENTS DISTANCE TO NEAREST: WELLit FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES Cl LEACHING CHAMBERS #OF LINES LENGTH OF LINES_ A- DISTANCETONEAREST WELL it FOUNDATION It PROPERTY LINE ft MENr ❑ FILTER BED WIDTH ft LENGTH it DEPTH 4-.•/I cV/� DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it �D ❑ MOUNDED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 8 L3 SUMPS WIDTH ft LENGTH ft DEPTH 84AL ftft lJ DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE �._��SLJ!/ ❑ DISPOSAL PONDS WIDTH ft LENGTH fl DEPTH E.d/+�/.��/�/ COON Y DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE DRO FNTq� T ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH III RTMFNT DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft 1 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 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE Contractor DATE ----------------------- 119Fff--------------------- — --------- — ----------------- ------------------------ IL --------------- L/ DEPARTMENT US-E ONLY I /[ Application Accepted By [- Date t� Area tl �l Employee ID# I` Final Inspection By Date 1712A W ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pi Sump Soil Character: COMMENTS PE SC Received Check#1 Amount Date Permit/ Invoice# Permit ID# Code INF. 6 C sh RemittedS�e7rvice Re uest# 07S G` 15� IC '51"MSI 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/24/12 eSW- • D ��