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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY E IRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE - 3" FL - STOCKTON CA 95202 - (209) 468-3420 NDN-REFUNDAAU PERMIT CALL 209) 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUEn Jos ADDRESS CROSSSTRcrr WI;5 t OF �" '6Y APN05t-5 0-(:)6 PARCEL SIZE 1 3 OWNER NAME Y FF-- Nc— PRONE OWNER ADDRESS /Y CITY/STATE/ZI��5�� r.,..o., n.Q • AGG t]Ct^\•7 OTHER w a e WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y Character of Soil to Depth of 3V+. .� ,-� Pit)Sump Soil Character: '6iaj�. e ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK. NEW INSTALLATION h Amouat Permit/ Dale ee r it I ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE Cash Remitted Service Request # 4-2-- -13Sa.oj V ❑ REPLACEMENT ❑ DESTRUCTION .E-�j"� 4 E -`WA R PERA�F'" INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER NUMBER OF LAYING UNITS: NUMBER OF BEDROOMS: NUMBEROP EMPLOYEES; SEPTIC TANK TYPE/MFG7 I CAPACITY gal # OF COMPARTMEN?5 ❑ CREASETRAP TYPEJMFG CAPACITY, gal #OF COMPARTMENTS ❑ PKC TX PLANT DISTANCE TO NEAREST: WELL ft FQUNDATION 60 R PROPERTY LINE100 ft M LIFT STATION N �/�]�r tj SIZB TYPEOPPUMP ftt6 ❑ YN LX31 .�L�I I SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES YLEACHINGCHAMBE OF L- � LENGTH OF LINES 50 ?,'�'.NDAT.. ft DISTANCE TO NEAREST WELL I R PROPERTY LINE � � R � ❑ FILTER BED WIDTH R LENGTH R DEPTH ft DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH R DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R O SUMPS WIDTH R LENGTH R DEPTH R T DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTY LINE R ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL—eft FOUNDATION ft PROPERTY LINE �j'�R 492 �1 SEEPAGE PITS NUMBER J WIDTH C J 7 ►t�/)�/fl DEPTH ft �( ._ DISTANCE TO NEAREST WELL, x/25 ft FOUNDATION 100 R PROPERTY LINE 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. L� SIGNE �,dL�4,�1�L[J MI IMI� OTICE REQUIRE] INS ' IONS- PLE SE CALL (209) 953-7697 FOR TITL� ATE �— I Applicatiar Accepted B DEPARTMENT USE NL t -I — tc i ZQ Arra 12Employee ID# Final Inspection By �t-! Date /a�9� ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3V+. .� ,-� Pit)Sump Soil Character: '6iaj�. e COMMENTS CLQ.l--c 0,- GA I?_J) ig i)s - o C O 31' . rr 46T - L -co .� PE I SC Received h Amouat Permit/ Dale ee r it I Code INFO B Cash Remitted Service Request # 4-2-- -13Sa.oj V 42-02-00I -.ter-r'�Y� .E-�j"� 4 E -`WA R PERA�F'"