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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT -/�? 670 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE -3" FL-STOCKTON CA 95202 - (209) 468-342P <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE I T' <br />JOB ADDRESS _.JS i27_�y ft /- I SSUED <br />C17Y!?JP �� fS <br />CROSSSTREET y,> a. APN S PARCEL SIZE <br />OWNER NAM �i� ^� Nel <br />�D i <br />PHONE <br />OWNER ADDRESS �f ` Vol <br />G CrrYJSTATE/ZIP <br />CONTRACTOR IA ucv <br />PHONE � 'SaZ <br />CONTRACTOR ADDRESS �.YpJ / Jy�+v s - __ _ _ _ <br />� 1 i <br />LICENSE C-02 ❑ C-36 OTHER NUMBER Q Oq <br />E%PIRATION DATE <br />WATER TABLE DEPTH:— R GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />❑ PERC TEST # BUILDING PERMIT# <br />�2�n "ZCi 2CO LAND USE APPLICATION # <br />TYPE OF WORK: Vk NEW INSTALLATION ❑ REPAIRIADDTrION <br />❑ ENGINEER DESIGNED !ALTERNATIVE <br />❑ REPLACEMENT ❑ DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL �j ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: C <br />NUMBER OF EMPLOYEES: <br />�- SEPTIC TANK TYPEIMFG—CAPACITY 1600 gal *OFCq <br />OMPnRTMENTS_ry GREASE TRAP TYPElMFG CAPACITY <br />r, gal It OF COMPARTMENTS <br />❑ PKG TX PLANT DISTANCE TO NEAREST: WELL _ R FOUNDATION y <br />R PROPERTY LINE <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES ❑ LEACHING CHAMBERS #OFLrNESmoi'^ <br />� LENGTH OF LINES ' ft <br />DISTANCE TO NEAREST WELL J �i0 �%- ft FOUNDATION <br />❑ FILTER BED WIDTH R PROPERTY LINE . IE421 R <br />ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL _ ft FOUNDATION R PROPERTY LINE R <br />❑ MOUNDED WIDTHR <br />ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL _ ft FOUNDATION (I PROPERTY LINE <br />L3 SUMPS WIDTH ft <br />R LEND"iH ft DEPTH R I <br />DISTANCE TO NEAREST WELL __ ft FOUNDATION R PROPERTY LINE <br />LIR <br />DISPOSAL PONDS WIDTHft <br />LENGTH R DEPTH R <br />DISTANCETO NEAREST WELL ft FOUNDATION R PROPERTY LINESEEPAGE PITS NUMBER ft <br />WIDTH _ �(c,E� fl DEPTHaS� ft <br />DISTANCE TO NEARESTWELL J Sb t R FOUNDATION ft ft PROPERTY LME S -Z)' ft <br />1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL. BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />NIINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 9$3.7697 <br />SIGNED 4�d <br />TITLE_ DATE IV -Z(10-1 <br />/J DEPARTMENT U E ONL <br />Final Inspection B ate <br />DEPARTMENT <br />— <br />SPECIAL PERM1IIT -Approved by <br />Applicatinn Accepted By ,,4` Date <br />Area Employee IIA4 <br />D/-.yI/n-� ❑ T <br />Character of Soil to fikpfh of3 r. � Pit/Sump Soil Character:�— <br />COMMENTS 4VAI <br />1:122n_OD3 ONSITE WASTEWATER PERMIT <br />a <br />e <br />0 <br />n <br />