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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1888 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3820 <br /> NON-REFUNDABLE PERMIT CALL209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED a/ <br /> JOB ADDRESS I X257 AI JA,GiC 'M.nw+ au CITY/ZIP i-_UDx„ q a'l40 <br /> CROSSSTREET HNR.NEy LtV APN 06326012 _ -..-PARCRLS9:111 <br /> S <br /> OWNER NAME R�{TE{. ,-trl►z( PHONE ! <br /> OwNFR ATNTFKSS Sa1118 CITY/SiTATWIP <br /> CONTRACTOR J-$_1'c/+J471?u-4r 1v �...t EPTzcl. _Tp�_ PHONE `II U r2.4.- `{I`'? <br /> CONTRACTOR ADDRESS `a`Sl"/ ll1L'/�Rl+ct_7/ ��<t� act tt 2ac• CRY/STATE/ZIP -_ <br /> /. <br /> LICENSE , 10-42 ' C-36 Gitirn NUMBEA Y24"174- EXPIRATION DATE CL-/ ULC> <br /> WATER TA13LE DEPTH: 1t GEOGRAPHICAL INFORMATION: COatdinates X Y <br /> PERC TEST • BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEw INSTALLATION REPAnVADDINoN ENGINEER DESIGNED/ALTERNATRIE <br /> REPLACEMENT OUT-OFSERVH)E SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: V RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: Z NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG G.,','Ar-IT+ gal 1ICIFCOMPAKTMENT5 <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal O DF-COMPARTIAETITS <br /> DIBTANCETO NEAREST: WE--11 ft FoUNDATIC', ft PROPERTY LWE R <br /> 0 LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES V LEACHING CHAMBERS 1 r1 :� �d1r�. MOF LINES ._- _. LENGTH OF LINES Y(7 ft <br /> DISTANCE TO NEAREST WELL /Oce It FOUNDATICN ?6 ft PROPERTY LINE S ft <br /> O FILTER BED WIDTR ft LENGTH ft DITH ^ fl <br /> DISTANCE To NEAREST WELL ft FOLIN aATIOn ft PROPERTY L:NE ft <br /> CI MOUNDED WIDT71 ft LENGTH R i}PTH fl <br /> DISTANCE TO NEAREST WELL R FGUM_ATICN it PROPERTY L'.NE ft <br /> ❑ SUMPS WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NeAREST WELL R 90UNDATION ft PROFE.RTY LINE fl <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH fl <br /> DISTANCE TO NEARlST %.YELL R FOUNDATION R PROPERTY LINE Tt <br /> SEEPAGE PITS Numeen Warm i G ft DEPTH S !t <br /> DISTANCE TO NEAREST Iiwu /So` R FOUNDATION 7C R PROPERTY LINE ft <br /> HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAGUIN COUNTY. <br /> M041mum UR Al2VANQE NOTICE REQUIRED MR INS CTIQNS-PLEASE CALL 1202)2Q- 97 <br /> SIGNED <br /> / -_ TITLE_ TTt�w' DATE U / 2 aZL, <br /> _ <br /> yr <br /> J <br /> -- -- A NN <br /> R <br /> DEPARTMENTUSE ONLY <br /> Application Accepted B l✓� Date LiI'1 I.oZD Area Employee ID# sk <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS Fu;Iuie of sys�Gi Ter <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# <br /> a l o 115 3oa I 2v S12 p �- <br /> 42-01 (fv'4 G 07 5 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 41/14/18 <br />