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• i ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 MON-REFUNDABLE PERMIT CALL 209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS �rt3o ST pT \"Z /CITTY/()Z�IIP �00 9SZ�Z CROSS STREET /\�%tiN�W�X (Z� APN O ( 1 I D PARCEL SIZE OWNER NAME Z /tKR y 'wc-C PHONE OWNER ADDRESS l I � 3 O S % '11'-r[2 CITY/STATE/ZIP Loin/ e-, �5 2`4{ 2" CONTRACTOR Ts 3 'fEPV,-r-, 1 - ye PHONE ( I I0 L(-7 1-124 SS Q CONTRACTOR ADDRESS �%%� �O.N �� K 1i�.. SK�TC X00 CITY/STATE/ZIP 5-C LICENSE LIQ'/; -42 ❑i C-36 OTHER NUMBER $Z2_f3& EXPIRATION DATE d_ �3e>h02rj 1 11 WATER TABLE DEPTH: W .4s V ft GEOGRAPHICAL INFORMATION: Coordinates X Y El PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION r ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM I I DESTRUCTION INSTALLATION WILL SERVE: f_l RESIDENCE IT COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: V SEPTIC TANK TYPE/MFG C.P>N� C CAPACITY /-TOO gal # OF COMPARTMENTS �L LI GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS 1 DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft 0 LIFT STATION SIZE TYPE OF PUMP El PKG TX PLANT El SAND OIL SEPARATOR (ENCLOSED SYSTEM) VLEACH LINES IY LEACHING CHAMBERS Wyn— #OF LINES LENGTH OF LINES SS ft Date Permit/ Service Request # Invoice # 1 x-21 I �w 1 5$ DISTANCE TO NEAREST WELL I %� ft FOUNDATION %`� ft PROPERTY LINE si/ ft El FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft El MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft Q SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft E] DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft % DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft � C� SEEPAGE PITS NUMBER 1 WIDTH �� ft DEPTH .x151 ft DISTANCE TO NEAREST WELL. /Sb' ft FOUNDATION 3oi ft PROPERTY LINE �®1 ft I HEREBY CERTIFY THAT I 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 48 HO R VANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE )2R6S7:>f _r_ DATE 0S.z2 Zz4 % Application Accepted Final Inspection By Character of Soil toDeJ'th of COMMENTS 6 f .. L 0 PARTMENT USEhNLY Date Area Employee ID# l�!/ Date ❑ SPECIAL _E R__M'1T -Approved by Pit/Sump Soil Character: �� ✓vr�n Per 8.4a,0 ki-A! Nl_S/SSS roC"Ca lP r PE Code Sc INFO Received Check#/ Cash ALnOUnt Rem' d Date Permit/ Service Request # Invoice # Permit ID# x-21 I Asa. 5$ 22 i S t2 es 42-01 ' 'C � h • ONSITE WASTEWATER TRTMNT SYSTEM PERMIT v. •s. v n