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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT I M E. HAZELTON AVENUE • STOCKTON CA 95205 - {208} 488-3420 <br />NaN-fiEFUNDABLE PERMIT <br />CALL L209 <br />j 953-7697 FORIN5PE'Cro" <br />EXxpim I YEAR FROM MATE ISSUEI <br />JOS ADDRESS �- <br />� I T It b <br />CirYiCiP, 12�E <br />AJ C• N <-A M P Orr L 3 1` <br />CROSS STREET . N1 A 1,J <br />APN j <br />" i•iO - '�i '",_ <br />PARCEL St. I.' t fp'1C . <br />q�ii <br />OWNER NAME YX I�A <br />6raXLb A.i <br />ft <br />J 7 <br />PHONE i ��X) 7"Zr3 ^ -7J r0 <br />OWNER ADDRESS r.O • J70A <br />i O D <br />CifYJSTArvZp 1'• <br />LAXf. 'Tpti'f- CA IrIrf <br />CONTRACTOR ;.-111e DA14 <br />d <br />PHONE <br />�to -0 <br />CONTRACTOR ADDRESS <br />0 Ak -'ST. <br />CITYISTATL7JP <br />3•• t1 I' ( c/A Ir! a 1.4 0 <br />LICENSE ❑OC42 ODC•3S OTHER C E (v- NUMBER "21 S' ! <br />EXPIRATION DATE <br />4 <br />WATER TABLE DEPTH: _ ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />FERC NEST # i3UiLDING PiERMIT # LAND USE APPLICATION <br />TYPE OF WORK- C" NEw INSTALLATION D REPAwdADoam U ENGINEER DESIGNED /ALTERNATIVE <br />.. REPLACEMENT LI OUT -OF -S RME SEPTIC SYSTEM TJ DESTRUCTION <br />INSTALLATION WILL SERVE: C7 RESIDENCE Ci COMMERCIAL 11 OTHER <br />NUMBER OF Lmw UNITS:.. NUMBER OF BEDROOMS:, NUMBER OF EMPLOYEES:..... <br />E3 SEPTIC TANK TYPEJMFG CAPACITY gal # OF COMPARTMENTS <br />Q GREASE TRAP TYPEIMFG CAPACITY 94 # OP COWARTMENTS <br />DISTANCE TO NEAREST: WELL it FouNDAT" It PROPERTY LINE ft <br />U LIFT STATION $29 � _ V - TYPE OF PUMP a PKG TIC PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />(3 LEACH LINES <br />t:1 LEACHING CHAMBERS <br /># oPl wEs <br />LENGTH OF Lwes It <br />DISTANCE To NEAREST WELL. <br />ft POUNDAT ON <br />ft PROPERTY LINE ft <br />U FILTER BED <br />WaSTN ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WEU. <br />ft FOUNDATION <br />ft PROPERTY LINE ft' <br />G) MOUNDED <br />WIDTH ft LENGTH <br />it <br />DEPTH qA It <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />ft PROPERTY LINE Y <br />C1 SUMPS <br />WIDTH it LENarH <br />it <br />DEPTH <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />L7 DISPOSAL PONDS WIDTH ft LENGTH <br />it <br />DEPTH n <br />DI -STANCE TO NEAREST WELL <br />it ftA3HOATION <br />it PROPERTY UNE R <br />Ll SEEPAGE PITS <br />Numsen ___ Worm <br />ft <br />DEPTH R <br />DISTANCE TO NEAREST WELL <br />ft FOUNOATION <br />ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUiN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br />MLWMVMjj..H0UR <br />SIGNED <br />09YA NOTICE REM= <br />FOR INSPEC77ONS <br />TITLE PJAL03. <br />- PLEASE <br />AA&j44,,. <br />CALL 1209) 953-769 <br />DATE k-1- 2 2.. <br />r� of T fu ����? c� <br />Application Accepted BY t Dame Arcs EIrllpioyeee iD# <br />Final inspection BY Date 0 SPECIAL PERMIT-Appmved by <br />Charaeter of Soil to Depth of 3 Ft:_ W P'"Urnp "I Character - <br />COMMENTS <br />LINN FROM, <br />42-01/ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />14178 47 <br />9It __ ii 77 -JY" j _.S✓ <br />� i <br />N �'V4 <br />