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ONSITE WASTER'ATER TREATMENT SYSTEM PERMIT ria °°) JAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Spa E W ERER AVE - 3°1 FL - STOCKTON CA 95202 - 12119% AAR-id7n 7iUIN-KEFUNDABLE PERMIT CALL_ (209) 953-7697 FOR INSPECTIONS EXPIRES I YEAR PROM DATE ISSUED JOB ADDRESS 'CITTYY///ZIP_ CROSS STREET APN C� q 300 —' PARCEL SI7i-_y�o_ 9 r AG(�., OWNER NAME e-erp,% L'Yfl/L� _ 'NO1NE eG SOyu-2/p �_- ORNER ADDRESS 22 14 -0 1N�p �`p��. n} CITY/STATE/ZIP _ I--�11 A stn Cr 'Inc �— ` p ,�r� CONTRACTOR •q /�� 1y.`{ � PHONE Z� � �-)�/pr— � ��7�_` CONTRACTOR ADDRE;CS �G��,C F Myrl { 1. CITYISTATF%ZIP LICENSE ❑ C-42 ❑ C-36 OTHER NUMBER EXPIRATION DATE ❑ LEACH LINES ❑ LEACHING CHAMBERS # OF LINES _ LENGTH OF LINES -----------•••^_ n ULE—rH1UAL INFORMATION: COOrdinates X V f� 1 IMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR CALL (209) 953-7697 PERC TEST (S) NUMBER _ Y LAND USE APPLICATION # TYPE OF WORK; ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT ❑ DESTRUCTION INSTALLATION WILL SERVE: 13 RESIDENCE L3 COMMERCIAL ❑ OTHER BE NUMR OF LIVING UNITS: NUMBER OF BEDROOMS: _ NUMBEROFEMPLOYEPS: ❑ ❑ SEPTICTANK TYPPMFG_ CAPACITY gal {y OFCOMPARTMENTS GREASE TRAP TYPE(MFG CAPACITY gal # OF COMPARTMENTS ` ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION ft. PROPERTY LINE ❑ LIFT STATION It SIZE TYPE OF PuMP Q SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS # OF LINES _ LENGTH OF LINES It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ❑ FILTER BED WIDTH ft LENGTH ft DEPTH DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ MOUNDED WIDTH ft LENGTH ft DEPTH_ DISTANCE TO NEAREST' —• WELL ft FOUNDATION_ ft PROPERTY LINE LI sumps WIDTH ID R LENGTH ft DEPTH DWVANCETO NEAREST WELL ft FOUNDATION- ft PROPERTY LME ❑ DISPOSAL PONDS WIDTH ft LENGTH ^ fl DEPTH DISTANCE TO NEAREST WrLL ft FOUNDATION ft PROPERTY LME ❑ SEEPAGE PIT'S WIDTH R LENGTH It DEPTH DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINEft ft ft ft It it ft ft It R ft 1 HEREBY CERTIFY TRAT 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. f� 1 IMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR CALL (209) 953-7697 �i,NSPECIIONS-PLEASE ��..�� SIGNED r ,,,-. %� g� y -s Ehalncer DATELf�•t` Application Accepted By Final Inspection By__` Character of Soil tri Dept %Tea Employee ID#_ 53(4 pr �._ 13 SPECIAL PERMIT -Approved by !� Solt Character: "%-ti-� it=/r� lagr► UNSITE WASTEWATER PERMIT