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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E HAZELTON AVENUE-STOCKTON CA 85205-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 9153-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED Joe ADDRESS �� j /dC'Ste ] CITYILIP s CROSS STREET fCX: ., V - APN I/ 1 PARCEL SIZE r X OWNER NAME 1., I J C PHONE OWNERADDRESS �' - �L'C ✓i.S Ave- / CTTY/STATEILP � t✓'-I L," /S� 1 CONTRACTOR / 'j,/-7 t7/' /_r�[', PHONE .(SZ�0�/� CONTRACTOR ADDRESS -]/- -U -YJ�J//�- /�/� CfTY/STATE/ZIP J/UGYm+'�7 iLICENSE -,0-42 ❑ C-36 OTHER NUMBER � J b/ EXPIRATION DATE_�� ?/ ZC• WATER TABLE DEPTH: h GEDGttAPHICAL INFORMATION: Coordinates X Y PERC ST n BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: TENEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATWE REPLACEMENT OUT-OF-SERVICE SEPTI_SYSTEM DESTRUCTION IG INSTALLATION WILL SERVE: j RESIDENCE _ COMMERCIAL L: OTHER NUMBER OF LNING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: _ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPEIMFG CAPACITY gal 3t CFCOMPARTMENTS DISTANCE TO NEAREST: WELL h FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE _._ TYPE OF PUMP _ __❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINEs LENGTH OF LINES h DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft 0 FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST V'A'-Lit FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE To NEAREST WELL it FOUNDATION_fl PROPERTYLINE ft ❑ SUMPS WIDTH ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE f, ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft DISTANCE To NEAREST WELL It FOUNDATION h PROPERIYLINE it ❑ SEEPAGE PITS NUMBER-_- WIDTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION R 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 48 HOUR ADYANCE NOTICE IR FOR INSPECTIONS-pLEAgE CALL f209)g53-7697 SIGNED --�� _ I^^.�' - TITLEC.+ fi _ - DATE _ PAYMENT I I APR �2 2044 20 114 1 t - L N Oq QUI I TN��AR oq NTy I TMENT I I I I [ / 7 P_EPARTMENTUSI ONLY Application Accepted By` Date / 0 Area I Employee ID> Final Inspection By Date L L C L SPECIAL PERMIT-Approved by Character of Soil t0 Depth 03 Ft: Pit/Sump Soil Character: COMMENTS T-h±)V„ C()-bAyl&0 PIRCf--f—h�- w� 5 � BLS i 45 PE SC Received Cheek#/ Amount Date Perm1T/ Invoice# Permit ID# Code INFO h Remitted Se I R uast# 1 75" 111AF eAed;t 411 1� ;SQ 0ou 00 42-0 4114118 - ONSITE WASTEWATER TRTMNT SYSTEM PERMIT /�'(J/%j�� 1b77�1�7�