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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS /3OO DFc rpt ,4 ✓E. CITY/ZIP_��G(/ 9'5.,04 j <br /> CROSS STREET T-� P�//Vi— APN —713-0219-3$�d•I PARCEL SIZE 4n,46 <br /> OWNER.NAME A44 V11 /Q/YJL� PHONE �r <br /> OWNER ADDRESS 7300DF-417A _CITY/STATE/Z/IP TftAGV <br /> F— <br /> CONTRACTOR C14 ^'C- L�LI7Y Ir04Srl" PHONE LSO ^G U.-2407 <br /> CONTRACTOR ADDRESS •10• MIOXnn3^^7 (Y CITY/STATE/ZIP TII A CO CIG r CA 9rIB f <br /> LICENSE LII:C-42 Eli C-36 OTHER PCE 9X'471 NUMBER EXPIRATION DATE 0-If-/f <br /> WATER TABLE DEPTH: —10 It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# It no <br /> TYPE OF WORK: i NEW INSTALLATION '7 REPAIR/ADDITION C. ENGINEER D IGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: n RESIDENCE P COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE fl <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL fl FOUNDATION It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH it LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE H <br /> ❑ MOUNDED WIDTH it LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH 9 LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl <br /> I HEREBY CERTIFY THAT I HAVE 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 /> MINIA 48 HZQ ADVANCE NOTICE REQUIRED FOR INSPECTIONS/ 6/-' tNE`- S CALL 2 <br /> SIGNEDk VA TITLE CI V/L & /Z DATE !r/-,Z I <br /> IP 14-11 T <br /> 4E IIL EP kw in <br /> Ll ARTMENT SE LY <br /> Application Accepted Byn Area Employee ID#7''y*� <br /> Final Inspection By DDate ate 6 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 1 P Sump Soil Character: <br /> COMMENTSm(f a I �✓1 <br /> PE SC Received Amount PermifJ <br /> Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# <br /> 4M qiA- 45 35 — Z <br /> 42-0I ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14113 <br />