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w; A ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SA}j JOOU.'1 COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)488.3420 i NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED •, j Joe ADDRESS qSO E1i11dDCI�7/i 0 e tl- CITY/ZIP � / n 4 I CROSS$YREET t/Jr/C � APIN O[ 7L PARCEL SIZE i0l o OWNERNAME 617rle,110 811 141,170 S US 9;6 Gr/�x1�/L.'�rI�� I(Z�e�PHONE/ OWNERADDRESS 16 9')x7X /,?&C) CITYISTATEIZIP //thn-1(J/I/U-/(AC_ G CONTRACTOR PHONE } 1 CONTRACTOR ADDRESS CITY/STATEIZIP LICENSE I;IC42 CIC-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: > It GEOGRAPHICAL INFORMATION: Coordinates X Y 1 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# f!` TYPE OF WORK: _ NEW INSTALLATION l REPAtR/ADDmON ENGINEER DESIGNED IALTERNATNE _. REPLACEMENT i7 DESTRUCTION INSTALLATION WILL SERVE: - RESIDENCE C COMMERCIAL _ OTHER T.{ NUMBER OF LMNG UNITS: L� NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ' SEPTIC TANK TYPE/MFG 7 CAPACITY 1�2_.d0'-K/JO gal #OF COMPARTMENTS ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION I /D ft PROPERTY LINE 1-25 - R LIFT STATION`', SIZE TYPE OF PUMP Lu PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) ;Y.• LEACH LINES ... LEACHING CHAMBERS-- "~r #OF LINES _ LENGTH OF LINES �?,1�( ft r t -D151ANCE EST WELL (. y R FOUNDATION 10 ft PROPERTY UNE / ft I` —C3 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 O DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft "(4� O SUMPS WIDTH ft LENGTH It DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY E _ SEEPAGE PRS NUMBER -17, 1 WIDTH :if,:?' It DEPTH QS ft DISTANCE To NEAREST WELL l,4jh ft FOUNDATION { 0 ft PROPERTY UNE 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. .�MIIN/IIVUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 p SIGNED . TITLE DATE Q ----_ --- ____a I L I&CIA I' - r•_.� �`�----------___ - _ .am u,rnc..r Application Accep e I—Date u a Employee ID#'�� ._+• rf"Final Inspection By - " - Date %i/lJy "7"SPECIAL-PERMIT=Approved by r Character of Soil to Depth A Ft: PiUSump Soil Character: I� .COMMENTS U I +' arc ' %�rrGnA+;. 7e^ f1, pwat� 12,0t PE SC Received Check#/ Amount Permlt/ i Date Invoice PermitlD# Code INfO -a B Cash Remitted Service R uest# 1. g•C-1•— v U l -- •�7i._f2s':� -�es�.br.E� '��ra+- ��r--c��6�-coli �i�z/cam ��„-� \ ONSITE WASTEWATER TRTMNT SYSTEMP�