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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT
<br />SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1068 E. HATyI. TOv AW NUE - STOCKTON CA 96205 - (209) 468-3420
<br />Nfim-REFUNDABLE PERMIT CALL (209)_953-7697 FOR INSPECTIONS- --rY EXPIRES 1 YEAR FROM DATE ISSUED
<br />DURESS Pr LL 1,�_,A,
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<br />OWNER NAME �Il�.�iy\{M rn,``4iM1f ._,. YNONE G"_''�"' •X"t•"" h�
<br />OWNER ADDRESS _ ,.. � „1f ,G ¢-... CIl'YiSTATEIZIP
<br />C PHONE It�
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<br />CIMSTATF.lZIP
<br />CONTRACTOR ADDRESS ��++ �__��
<br />LICENSE DOC -42 ❑OCJ6 OTHER t^V" NUMBER �•� ExwRAT1GN DA7L•-+� ice-✓' __.._.—_-_.._.
<br />WATER TABLE DEPTH: TSV -____ft GEOGRAPHICAL INFORMATION: Coordinates X .._..
<br />❑ PERC TEST 0 - BUILDING PERMIT #. � p LANi3 USE APPLICATION #_
<br />_.. �_._
<br />TYPE Of WORK: NE:W 1rtStALLATK7N REPktrUAGDrtON ... ENdirii`ER DE:
<br />'pS' REPLACEd1ENT _,(�I II- ❑ OLI-OF-SEIMCE SEPTIC SYSTEM -JC OCSTRUCTKJN
<br />INSTALLATION Wltt SERVE: Ty 9! RESSDfNGE ❑ COMMERCIAL ❑ ETHER._-_,
<br />NI)MGtR or I"Ma UMTSf-
<br />: ,•,• NUMBER OF BEDROOM-: _,,,,,,� NUMTiER OF EMP1.0
<br />SEPTIC TANK TYPFIMFO _ j_�_ �r_.� - - — CAPACITY I U� ii OF COMPARTMENTS
<br />L.1 GREASE TRAP TYPEJMFG ,..—_ CAPACITY gal !k OF COMPARTMENTS
<br />DISTANCE TO NEAREST Wf1L,��r__ it FOUNDATION R PROPERTY LINE ,__,,, „__�._n
<br />13 LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM)
<br />TERNAYNE
<br />U' LEACH LINES
<br />I1 LEACNiN{i CHAMBERS _, 8 or i_nsrs � LENGTH OF L1NEs _ 6 ft
<br />DMTANCE rO NEAREST
<br />WELT. Ii f0UNM1ION �, R PROPERTY UNE_ -_-5.- --- it
<br />�._
<br />❑ FILTERSED
<br />WTOTH
<br />ft LENGTH Del'TII_........._._ ft
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<br />_
<br />DISTANCE TO NEAREST
<br />WELL R FOUNDATION R PROPERTY LINE----.-. ft
<br />❑ MOUNDED
<br />WIoT}+ ...—.
<br />ft LENGTH it DEPIII
<br />_..._...__........_..___
<br />DISTANCE TO NEAREST
<br />WELL it FOUNDATION A PROPERTY❑NE R
<br />❑ SUMPS
<br />WIDTH
<br />R LENGTH ft Derl+I
<br />___.__..._..__...___...
<br />DISTANCE TO NEAREST
<br />WELL it FOUNDATION •„-_�.____ 0 PROPERTY
<br />f -j DISPOSALPONDS WIDTH
<br />ft LENGTH _•-, ....,..... .—tt DEPTH...._.__.___.._._„ fi
<br />..._.._...
<br />DISTANCE TO NEAREST
<br />Y+FSLit tt PROPERTY
<br />DT-� 1
<br />SEEPAGE PITS
<br />Nu+aaan _._.
<br />4FOUNDATION
<br />-1! ..TT
<br />W;ai^37 _. ___ �*__. __.— .. _.. ____�_ _ h DEPTH _per -._,,,.._._77
<br />RTY 11Nf ft
<br />DISTANCE TO NEAREST
<br />VgEu. �.h� it FOUNDATION..__.._
<br />ANC WITH SAN JOAQUIN COUNTY ORDINANCES,
<br />N ACCORDANCE
<br />1 HEREBY CERTIFY THAT I HAVE PREPARED THISWORKREGULILL B DONECC
<br />LAWS AND RULED AND AN N Y.
<br />I) ,4I
<br />HO ra anvttntGE
<br />NOTICE FZ QIlIFt D FOR /tIiSF'EC7IOfV5 PLE�sE CALL rzv=l) s •� 1
<br />TI'TL.E QV'1r3Ce- �r,•n i„•l, �ur DATE
<br />F1EAi ' DP PAR rMIeNT 4! Y
<br />cCj• 1� Date J 1 ,t ,,,1> An3a y — Employee IN `K
<br />Application Accepted By �_- �---
<br />Final Inspection By _ _ Data SPECIAL PERMIT - Approved by C&
<br />Character of Soil to Depth of 3 Ft:_ PitlSump Soft Character: _ _ -
<br />COMMENTS I If t wt 711 : 1, r. )F'i f. .; I�,tl It';; I ':; ELL- {n 1, 111 i: <.' t i
<br />PE SC Received hecfdl Amotmt _ Perm1U P'n
<br />valce tPermit ID#
<br />a !r FO Remitted Date Service Request # ..
<br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT
<br />404(18
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