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"I `�►�� %,, L-t`7-t6 1)A— ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIROfNENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERM/IT CALL 209 95.3-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS. n14 q Y (J•�+' •fir -CtTYIZIPr7 CNs�.�'tjn cif Z N CROSS STREET ilC--11 Afte 11 —_ APN l/�QIj�b��Q�� '14--T ---,-J�—PARCEL SIZE OWNER NAME�IIR (-! /t _ .c:y^T�o IL��__.,(—j( tlt7flvl_ A II�LU.^r�PFfONE��1 a� -7 D IN" ti -- - 1 OWNER ADDRESS . tle�-7 CfTYISTATEILP CONTRACTOR On "kG=S4 1�1 �K(I-C- 15k'/•'-___— PHONE �yy'� �(a• L CONTRACTOR ADDRESS P(�r2ctx 4, a. —__ --CITY/STATEIZIP Y/ 1�7�Il♦�F[:r_�^��C-✓r- Tom],�; LICENSE ❑I C-42 C-36 OTHER 44 NUMBER .EXPIRATION DATE,Dj t 1 WATER TABLE DEPTH: If GEOGRAPHICAL INFORMATION: Coordinates X ❑ TEST d BUILDING PERMIT# _ ___ LAND USE APPLICATION# TYPEE OOF F WORK: NEW INSTALLATION REPAIRIADOMON ENGINEER DESIGNED/ALTERNATIVE X REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: �sIDENCE t] COMMERCIAL 11 OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:._—I-L _ NUMDER OF EMPLOYEES: P-1-SEPTICTANK TYPFJMFG �¢ L CAPACITY- j(e be\ gai BOF COMPARTMENTS—�_ ❑ GREASE TRAP TYPE/MFG CAPACITY coal B OF COMPARTMENTS DISTANCE TO NEAREST: WELL �,t R FOUNDATION (e;o t it PROPERTY LINE _r]�I it ❑ LIFT STATION SIZE TYPE OF PUMP_____-_._.__ LIPKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) &---LEACH LINES i LEACHING CHAMBERS __-- B OF LINES_ LENGTH OF LINES Loo j it DISTANCE To NEAREST WELL !>D L h 7 FOUNDATION- L C,_1_.—_It PROPERTY LINE t-"' It Cl FILTER BED WIDTH It LENGTH __.._.. . N DEPTH it DISTANCE TO NEAREST WELL -- It FOUNUATIUN It PROPERTY LINE it ❑ MOUNDED WIDTH it LENGTH ft DEPTH it DISTANCE TO NEAREST WELL _ it FOUNDATION It PROPERTY LINE It ❑ SUMPS WIDTH It LENGTH ...___ _______ ft DEPTH it DISTANCE TO NEAREST WELL it FOUNDATION It PROPERTY LINE K ❑ DISPOSALPONDS WIDTH it LENGTH—_.— it DEPTH it DISTANCE TO NEAREST WELLR FOUNDATION_ _it PROPERTYLNIE it WISEEPAGE PITS NUMSER u WIDTH�} 1_�!_.— it DEPTH 2,,f/ It DOTANCETO NEAREST WELL-4-a,,,!— R FOUNDATIONI� 7f�t it PROPERTY LINE 1.f7 t R 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOLRN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED -----------..... TITLEC— ,l CSL. iC_.---- DATE Ze — r• F.. Z -I — W 0 zWa — -Is;Lu —50w _ xx 7 ( 6 QZ — LL - to >: 431•qF ARTMENTUS ONLYApplication Accepted BJ _ Date_ /Area - _._. Employee IDBfl Final Inspection By �1Yr/?IA )cMOrs�G_r�� Date_ 7�-/bo SPECIAL PERMIT-ADpravedby Character of Soil to Depth of 3 Ft: _-___ _ Pit/Sump Sall Character: COMMENTS 01-C! Ld2ZCF— 96ica 42 PE SC Received CheekB/ Amount Permit/ Code INFO By Cash Remitted Date Service Re Uest.# Invoiced Permit IDB 4210 ( I la 24 _ � ��2 - — 42-01 ONSITE WASTEWATER TRTItNT SYSTEM PERMIT 4/24112