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Nut) Nay�,NtL Pcwu -s <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTUM 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)46&3420 <br /> NON-REFUNDABLE PER T CALL MW 953-7697FORINSPECTIONS EXPIRES 1 Y FOM DATE ISSUED <br /> JOB ADDRESS CRY//ZP( LA KrDP,� <br /> �/� _l <br /> CROSS STREET �'w} PN_ ViI —lJ��JL <br /> QPARCEL SIZE .0 <br /> OWNER NAME [//���,���JTT(J. l N �L./n�Lam_ PHONE •3 1 rC � <br /> OWNER ADORESSS/�A 4G t� CtrY/STATE/ZIP _ <br /> CONTRACTOAD-A. i�RS t� OfW '�}t_C PHONE (]\yam/,\ <br /> CONTRACTOR ADDRESS I-J l/Mcn U 1 - -4—CITY/STATE2{P till'l..J� 152 <br /> - <br /> CONTRACTOR <br /> )CC-42 �jC-36 OTHER—.-A----. NUMBER I�lI EXPIRATION DATE <br /> WATER TABLE DEPTH: _ it GEOGRAPHICAL INFORMATION: Coordinates X_ Y <br /> C PERC TEST N _ BUILDING PERMIT#_ �- LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAiR/ADDITION ENGINEER DESA /AL TTVE <br /> REPLACEMENT __. _ OUT-OF-SERVICE SEPTIC SYSTEM DTR.CTpN, � <br /> INSTALLATION WILL SERVE: jC RESIDENCE Ii COMMERCIAL OTHER <br /> NUMBER OF LIVING UNtrs: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG__ _ CAPACITY gal A OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG _- CAPACITY_ _ gal A OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL __- it FOUNDATION _- It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PTUMMPP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES )CLEACHING CHAMBERS t7 _ 10F LWEs—ttt__ LENGTH OF LINES �J it <br /> DISTANCE TO NEAREST WELL+__ ft FOUNDATION1�+ __it PROPERTY UNE c J+ R <br /> ❑ FILTER BED WIDTH It LENGTH___ ft DEPTH it <br /> DISTANCE TO NEAREST WELL__ it FOUNDATION__ _it PROPERTY UNE it <br /> ❑ MOUNDED WIDTH _ ft LENGTH it DEPTH it <br /> �,( DISTANCE TOO NEARE j WELL _ it/FOUNIDATION It PROPERTY LINE R <br /> }I SUMP$ WIDTH Ii !Z,ItTH y L ft_-- DEPTH it <br /> DISTANCE To NEAREST WELL it FOUNDATION it PROPERTY UNE cJT R <br /> ❑ DISPOSALPONDS WIDTH_,_, ___it LENGTH_ _ it DEPTH _it <br /> DISTANCE TO NEAREST WELL it FOUNDATION _it PROPERTY UNE it <br /> ❑ SEEPAGE PITS NUMBER "_ WIDTH -___ ft DEPTH it <br /> DISTANCE TO NEAREST WELL--.--- It FOUNDATION__it PROPERTY LINE it <br /> I HEREBY CERTIFY THAT I HANE 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 /> QM*M4r <br /> H U REQUIRED FOR/ O - LEASE CALL(2091953-7697 <br /> SIGNE 1 AW TITLE DATE 1 <br /> Ca <br /> Jp;l <br /> ocna <br /> iT 1 NVIf <br /> i II r <br /> - <br /> FT FFF <br /> J 1 1 1 1 — I H <br /> 1 <br /> DEPARTMENT USE ONLY <br /> Application Acce y_ ' nate- 6 !� Area Employee IDA ScJ <br /> Final Inspection B' Date �� _ i 1 SPECIAL PERMIT-Approved by <br /> Character of Soil to epth of 3 Ft:_-__ `,!� , f�� I- <br /> 1 <br /> _- dit/Sump Soil Character: <br /> COMMENTSjigAl .4 �Y to •. •th fP.stari CGr� a�� <lu <br /> �yyFttn 1_. ��•. ltrsL.E •-L/ . <br /> ,nV dr, <br /> PE SC Received Ch Amount - Date Permit/ Invoice N Permit IDI <br /> Code INFO By, Remitted Service Re uest A <br /> SQ40 l09 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4.'24112 <br />