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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE - 3" FL - STOCKTON CA 95202 - (209)468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS i 3_6_2_,,v. 0 e e-7/4- 740 CITY/ZIP 7.7.4tel <br />CROSS STREET /Ir-1--/.4—,4-e..) i ',..: E.- APN -',Z 1. 3 — / 06 - 2-3 PARCEL SIZE / • 6.; :- <br />OWNER NAME 0--/ I F .66...14/5fI' r-A-P <br />OWNER ADDRESS 3 7--2 Cuvc y <br />CONTRACTOR <br />o<2 <br />PHONE <br />CITY/STATE/ZIP CITY/STATE/ZIP 7/14z/ C-74 <br />PHONE <br />CONTRACTOR ADDRESS <br />CITY/STATE/ZIP <br />LICENSE 0 C-42 DC-36 OTHER NUMBER <br />EXPIRATION DATE <br />2" <br />"...111111 <br />1..1111 111110, <br />t4.) <br />c\ <br />z <br />j Pi <br />RF <br />JAN 1 -1-41 Iff <br />2 w fit p <br />§ <br />Character of Soil to De th of 3 t: Pt ump Soil Character: <br />COMMENTS Aiscc.) 1.-CT 7.- 4.-6•C. fa..-4 • /C1. us7- <br />ofc A-AJ F- <br />DLPARTME441 SE ONLY <br />Date 0-7 <br />Arra- Date / <br />Area Employee 113# 4&4.5.- <br />0 SPECIAL PERMIT - Approved by <br />Application Accepted By <br />Final Inspection By <br />N OF COMPARTMENTS <br /># OF COMPARTMENTS <br />PROPERTY LINE ft <br />CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />I &oo Sal <br />Sal <br />ft <br /> <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />PERC TEST <br />BUILDING PERMIT 4"05 ( 3 LL LAND USE APPLICATION # <br /> <br />TYPE OF WORK: NEW INSTALLATION <br />0 REPLACEMENT <br /> <br />INSTALLATION WILL SERVE: Z RESIDENCE 0 COMMERCIAL OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />0 REPAIR/ADDITION 0 ENGINEER DESIGNED /ALTERNATIVE <br />0 DESTRUCTION <br />4.,2( SEPTIC TANK TYFE/MFD6S1t1kkig— CAFAC <br />GREASE TRAP TYPE/MFG CAPAC <br />ft FOUNDATION <br />CI LIFT STATION SIZE TYPE OF PUMP <br />?KG TX PLANT DISTANCE TO NEAREST: WELL <br />2r LEACH LINES C2 LEACHING CHAMBERS tf OF LINES It LENGTH OF LINES /a) / ft <br />DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft <br />MOUNDED WIDTH <br />ft FOUNDATION ft PROPERTY LINE <br />f/ LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />El SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE, TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />C:2 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS NUMBER WIDTH ftDEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTy LINE <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />Itt 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE DATE 1 fix b 7 <br />PE <br />Code <br />SC I/ <br />INFO <br />Received <br />By <br />CChede) <br />Cash ..", <br />Amount <br />Remitted Date <br /> I Permit/ <br />Service Request*/ <br />_ <br />Invoice N Permit LEM <br />LI 2 11 ((7 isV Q---- ,C) I- \ '14 4( 5I)' Lkg 6 , (SD S g.0°(), 4 g <br />42-02-001 <br />12/220003 ONSITE WASTEWATER PERMIT <br />t f :SS38(10 V 311S