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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS p ,EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 2-411" S• +p1��S 1 ERA1 R�• CITY21P `f p^L-j I S"; 7 t7 4 U T c - ),4 CROSS STREET T- + APIN L S S - o2-0 PARCEL SIZE 1• 1 OWNER NAME C'tA A 17'r1N UTL^^ /�/JY•Y�F� Z.�/YL /!�/)�PHONE e37- _ U CAp� OWNER ADDRESS ,3c1 tt0 N 1 TR-�,f R l-V/}� • CITY/STATEMP T fes-«1 A `1V304 CONTRACTOR 1"1\ff Oft4- GE0 et'jV 1e0& L&-t-FA 1_ PHONE ;b r` 631 S 1 CONTRACTOR ADDRESS -+0_1 LA-). O r`� � q�• CITY/STATEIZIP L C'� r Ta-aT-0 LICENSE ,C-42 C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION -- ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES It DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE it ❑ FILTER BED VIDTH ft LENGTH ft DEPTH it DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE R ❑ MOUNDED WIDTH it LENGTH ft DEPTH It DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH R LENGTH it DEPTH It DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH it DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE R ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it I 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. MINIMUM UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE C a I jj v cT ft"T DATE r �-- -- --- VICINITY MAP Eli .4P°1+�= it _ I t -- --- - - � �� -L° � ''•0 rte. ori' h�Cie/ / iI 11111_ llLWW1llJ1 �_c_: .=~' / �Rp COON N F N7AL 1 EPARTMENT QN x I Application Accepted Date Area Employee ID# Final Inspection By Date SPE IAL PERMIT-Approved by Character of Soil t Depth of 3 F P' UMP Soil Ch cter: C MENTIS C 'n i � 1 PE SC Received heck#/ Amount Date Permit/ Invoice# Permit ID# Code INFO BY Rernitte&ol Service R nest# at—wi/ v 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT