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1 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. //{J N, 3 UR ADVANCE NOTICE: REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7647 SIGNED l / � , � ( TITLE ©w%+' u'�L- DATE 7-2.�—Lv— EPARTMENT : E O. V C Application Accepted Date Arca --- Employee 1D# Final Inspection By Date eC ❑ SPECIAL PERMIT -Approved by Character of Soil to pth of 3 t: Kt/Sump Soil Character: COMMENTS AZ 1057 CJP flZl!'�¢fi SC Received Amount Date Permit/ Invoice # Permit ID# IN. By Cash Remitted Service Request # - 42"02.001 ONSITE WASTEWATER PERMIT i ?,'22,7(01 LEACH LINES LEACHING CHAMBERS ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE - 3" FL - STOCKTON CA 95202 - (209) 468-3420 NON-REFUNDABLE PERMIT 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM D TE ISSUED JOB ADDRESS cC-�AZLL� -o c u J(/I s�� ^' ft FOUNDATION '+ 1%N U A'T �CII�(T}YIZIP n �I/� ! PARCEL SIZE (� • 2, CROSS STREET aS�S fC� LY APN !tel -� OWNER NAME ,4 Zt L" -A, PHONE ft �7E ��CN — OWNER ADDRESS I J �Q CITYISTATFALH, ` —Q CONTRACTOR f.J i © L., PHONE / ✓ "Z ft PROPERTY LME ft CONTRACTOR ADDRESS MOUNDED CITV(STATEIZIP it LENGTH LICENSE ❑ C-42 ❑ C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X I ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE ft ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: REstDENCE ❑ COMMERCIAL El OTHER NUMBER OF LIVING UNITS' 1 NUMBER OF BEDROOMS: /w NUMBER OF EMPLOYEES: ❑ SEPTIC TANK // TYPEiMFG_ L.Ou Lg& CAPACITY OC% gal #OFCOMPARTIIENTS ❑ GREASE TRAP TYPF/MFG CAPACITY gal # OF COMPARTMENTS ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LwE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAM1� OIL SEPARATOR (ENCLO5EDSYs—" 1 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. //{J N, 3 UR ADVANCE NOTICE: REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7647 SIGNED l / � , � ( TITLE ©w%+' u'�L- DATE 7-2.�—Lv— EPARTMENT : E O. V C Application Accepted Date Arca --- Employee 1D# Final Inspection By Date eC ❑ SPECIAL PERMIT -Approved by Character of Soil to pth of 3 t: Kt/Sump Soil Character: COMMENTS AZ 1057 CJP flZl!'�¢fi SC Received Amount Date Permit/ Invoice # Permit ID# IN. By Cash Remitted Service Request # - 42"02.001 ONSITE WASTEWATER PERMIT i ?,'22,7(01 LEACH LINES LEACHING CHAMBERS # OF LINEA LENGTH OF LINES f r 1 fc DISTANCE TO NEAREST WFL1 ft FOUNDATION '+ R PROPERTY LINE 1 ZS ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LME ft ❑ MOUNDED WIDTH it LENGTH ft DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH_ R LENGTH ft DEPTH ft' DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIKE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH fl DEPTH ft DISTANCETO NEAREST WELL ft FOUNDATION ft PROPERTY UNE 0 1 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. //{J N, 3 UR ADVANCE NOTICE: REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7647 SIGNED l / � , � ( TITLE ©w%+' u'�L- DATE 7-2.�—Lv— EPARTMENT : E O. V C Application Accepted Date Arca --- Employee 1D# Final Inspection By Date eC ❑ SPECIAL PERMIT -Approved by Character of Soil to pth of 3 t: Kt/Sump Soil Character: COMMENTS AZ 1057 CJP flZl!'�¢fi SC Received Amount Date Permit/ Invoice # Permit ID# IN. By Cash Remitted Service Request # - 42"02.001 ONSITE WASTEWATER PERMIT i ?,'22,7(01