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D ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAU:AN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZEL -TON AVENUE - STOCKTON CA 95205 -(209) 468.3420 NON-REFUNDABLE PERMIT CALL 1209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSttFO JDBADDRESS 2(�n s OOh'1fC -- CITY/Zip G 'hON S2O CRCSSSTREET `�1 I YGn f C (LSI r ij PARCEL SIZE I.) y OMER NAME rn PHONE 'DWNE� R ADDRESS �(I CITYISTATE/LP �I y CONTRACTOR Vvesf 06t hc,--/MC• P.C. jOG. 33`' 73q,4 CONTRACTOR ADDRESS 4W -el I CRYISTATEZIP L01A1 . 64 _{i-Lro 4r J / _ 51157 ;i / q2 LICENSE _ C-42 .: C36 OTHER NUMBER E%PIRATI'DNDeiF � SJ ZD23 WATERTABLE DEPTH: It GEOGRAPHICAL INFUNMAIIUN: Coordinates X Y PERC TEST # BUILDING PERMIT# �l LAND USE APPLICATION # TYPE OF W RK:NEW INSTALLATION ! 'V / ( REP4JR1ADDInON ENGINEER DESIGNED /ALTERNATIVE ft FOUNDATION ft PROPERTY LNE ft REPLACEMENT )rc • cd+ 1 0 T-OF-SERMCE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE If COMMFRCIAI. - OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMDER OF EMPLOYEES' ❑ SEPNCIANK 'YPFIMFG CAPAC TY gal # OF COMPARTMENT$ ❑ GREASETRAP YP=)MFG CAPACTY _- qal #OF COMPARTMEN rs _ft LENGT,i DISTANCE TO NEAREST: WELL R FOUNDATION ft ^ROPERTY LINE ft ❑ I IFT STATION SIZE TYPE OF PUMP D PKG TX PLANT El SAND OIL SEPARATOR (ENCLOSED SYSTEM) ti LEACH LINES LEACHING CHAMBERS lY1 cY #OFLINES LFN3TH OF LINES [VI R IIs G, 6 DEPARTMENT USE ONLY /� Application Accepted B — / G — Date ' /- ? Area �' J Employee ID#__A (-7 Final Inspection By Date 5-9--2,2- - SPECIAL PERMIT. Approve) by Character of Soil to Depth of 3 Ft:_ Pit/Sump Sall Character: COMMENTS 4Yr.I�•,_ uF rPsI�P,.CP. -� r�,; I..Pr<Ir r'r/ ,- ia C?rCCJ�✓lc:>(� crkiY��C SDc'Lr� c..a�T�G't �ti?c-� r%7C�l I f Z.F ��/, � .� ,. PE I SC I Received Chedc#1 Amount Date Pe;n Invoice # Permit ID Code INFD _ ash Remitted Service Request U 1r I; .3 , I -- F �1 1-I S 6 7 "11-6 -o 411411' Co --#--31-0 ( 'L T ��ili WASTEWATER TRTVINT SYSTEM PERMIT DISTANCE TO NEAREST WELL loo. T ft FOUNDATION (O " ft PROPERTY L NE ❑ FILTER BED WIDTH R LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LNE ft ❑ MOUNDED WIDTH it LENGTH f: DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE It U SUMPS WIDTH ft LENGTH f. DEPTH_ _ (t DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE R ❑ DISPOSAL PONDS WIDTH _ _ft LENGT,i R DEPTH R / DISTANCE TO NEAREST EA FI I. k FOUNDATION R PROPERTY UNF R 5 SEEPAGE PITS NRFR J IIN WIDTH 314I1 ft DEPTH 2-5- ft DISTANCE TO NEAREST_ WELL j n Tv4it FOUNDATION fl PROPERTY LINE j I, i I HEREBY CERTIFY THAT - 1 HAVE PREPARED THIS APPLICATION AND THE'NORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. STATE LAWS AND RULES ANU NEGULAr10NS OF SAN JOAOU W COUNTY. IIs G, 6 DEPARTMENT USE ONLY /� Application Accepted B — / G — Date ' /- ? Area �' J Employee ID#__A (-7 Final Inspection By Date 5-9--2,2- - SPECIAL PERMIT. Approve) by Character of Soil to Depth of 3 Ft:_ Pit/Sump Sall Character: COMMENTS 4Yr.I�•,_ uF rPsI�P,.CP. -� r�,; I..Pr<Ir r'r/ ,- ia C?rCCJ�✓lc:>(� crkiY��C SDc'Lr� c..a�T�G't �ti?c-� r%7C�l I f Z.F ��/, � .� ,. PE I SC I Received Chedc#1 Amount Date Pe;n Invoice # Permit ID Code INFD _ ash Remitted Service Request U 1r I; .3 , I -- F �1 1-I S 6 7 "11-6 -o 411411' Co --#--31-0 ( 'L T ��ili WASTEWATER TRTVINT SYSTEM PERMIT