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ONSITE WASTEWATER T13EATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE-3'D FL-STOCKTON CA 95202 -(209)468-3420 NON-REFUNDABLE PERMIT CA LI, 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS q!jf! f ,� CITY/ZIP J CROSS STREET RI 'A e C APN I73 020- PARCEL SIZE ( I O OWNER NAME I7g/�(. {1 4 � .(�,)[///�� n yPHONE 79-,2 7 /7,J N OWNERADDRESS W/ El 3 /1 A 15 FR.. /`� CITY/STATEIZIPS/ 7O/�/ ��/S J J CONTRACTOR PHONE CONTRACTOR ADDRESS CrrV/STATE/ZIP LICENSE O C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y rO FERC TEST # BUILDING PERMIT# B P Q S Q� 3 S7-LAND USE APPLICATION# TYPE OF WORK: NEWINSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: 1wRESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG T L CAPACITY I��f' pi #OF COMPARTMENTS �- GREASE TRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS o ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL 4- , ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION ��SIZE TYPE OF PUMP / (32SAND OIL SEPARATOR(ENCLOSED/SYSTEM) p LEACH LINES -1 LEACHING CHAMBERS -r'�- I� Tt'�--#of LINES J LENGTH OF LINES /DISTANCE TO NEAREST WELL S- -it FOUNDATION ft PROPERTY LME ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft V) ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft M DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 1 ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft Z DISTANCE TO NEAREST WELL RFOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER wmrx 5 (/Z- R DEPTH `Z ft DISTANCETONEAREST WELL ILC vI+W'FOUNDATION ft PROPERTY LME R m 1 HEREBY CERTIFY THAT 1 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. MMIXMUM 24 HOI!R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)9$3.7697 SIGNED /%Circe .✓'-Z-�.-�� TITLE t7 V-1 Al/:A DATE L7/ 41 r n y z e - r : NIR N E t � J DEPARTMENT TS LY / C Application Accepted By "- Date I Z� Area Employee ID# 7 Final Inspection By a Date 1, 211 0 ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS U+-f-I L YrfALz o/ 3 fj, -Ag-�, / rv•'<'Er'�-•% I xs6,24 nr/L de1 ft2=Wr e c .iG ti' C.!sje, lr� <�'li �QL, e -nhz<e._hr :% PE SC Received cc Amount Date Perm'/ Invoice# Permit ID# Code INPO By ash Remitted Service R uest# i 11- �(SO•J2� L c 42.02-001 /1{��./ ,� hG G=»"�c-ht� ril Cc�/�J7�YI"2✓C.Y +/ZtLI`Je�Z'r< /��' ��.�ii.AHSITE WASTEWATER PERK 11 Ivzvzoos 441 firm V. l�Y /=—/ . /.�.,4c�1� -2,1 clic tez moi? "�"/ Wit' ,A /v Gf �[ _fir k. -- h-c�_t :r+•n