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ONSITE WASTEWATER TREATMENT Say STIP[A PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -120914811.14211 WUN-KE—FUN—DABB-LEE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES'I YEAR FROM DATE ISSUE. Jos ADDRESS ! �t� j ,4 ,e jo I ? _ t�-��IC(— (�+f1 y� '• _ �/ CITY/ZIr CROSS STREET _ C 06 K W t`1_K,A rt- APN 1,3 5 0(, 033 PARCEL SIT-: OWNER NAME 1 7 (�C` yl.'jV •Q 1(-�'1'�I 3 ��y ). ��7y + —Z —7— '--T 4 PHONE OWNERADDRESS 3i0 Qi)i3� CITY/STATE1ZIP CONTRACTOR {it�.�.j'� 7 tL7° /'��`G-- PHONE CONTRACTOR ADDRESS __._1C [,i.' -U �, CITY/STATEIZIP i��"'/11�4•'^G+ I✓7'3 LICENSE OUC-42 ❑IJC-36 9THER ),(.L NUMBER, EXPIRATION DATE.___�� WATER TABLE DEPTH: ❑ PERC TEST # _ ft GEOGRAPHICAL INFORMATION: Coordinates X Y( BUILDING PERMIT # LAND USE APPLICATION # ON REPAIRIADDITION ❑ ENGINEER DESIGNED(ALTERNATIVE REPLACEMENT &4CII P18U _ (1 OUT -0F -SERVICE SEPTIC SYSTEM 0 DESTRUCTION INSTALLATION WILL SERVE: &RMSIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: ! NUMBER OF EMPLOYEES' ❑ SEPTIC TANK TYPEIMFG CAPACITY gal # OF COMPARTMENTS13 _ GREASE TRAP TYPE/MPG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL fl FOUNDATION _ _ ft PROPERTY LINE ft ❑ LIFT STATION SIZE --TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (EN/CLOSED SYSTEM) LEACH LINES ❑ LEACHING CHAMBERS ##OF LwEs r" LENGTH OF LINES DISTANCL-TO NEAREST WELL-- ft ft FOUNDATION__I ) ft PROPERTY LINE.- int t{ FILTER BED WIDTH _ ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE i; CE MOUNDED WIDTH ft LENGTH ft DEPTH f{ DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft U SUMPS WIDTH __ ft LENGTH _ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft CB DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R DISTANCE TO NEAREST WELL1t FOUNDATION � ft PROPERTY LINE - ft SEEPAGE PITS NUMBER— p WIDTH ?(.I' ft DEPTH _! ({ DISTANCE TO NEAREST WELL( Rn( ft FOUNDATION + ft PROPERTYUNE_. S $ T 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. SIGNED TITLE G .�/1s,�a� DATE Application Accepted Final Inspection By Character of Soll to Depth of 3 COMMENTS Fax{lore ofsys N AF_PART 4NA Datea / � ,�y%t%�/t Area � qq Employee IDtk btt Date a iv Lv rSPECIAL PERMIT - Approved by — PitlSUmp Soil C aracter. r7 PE SC Received 'Zhock#V Amount PermiV ■:■■.■■■■■■■ ZNTI— Remitted ■■■■■■■�MEN ■. ©':■��RI► No ME ■ ■■■■■■..■■ . ......�,SOMME � ,:7■■ 1101 ■■■■■■ ■..E■■■...�..�!�...■■■■■■ ■■■■■■■�■ Im ■I�Ifi��iiiiw `■mon"m■■. ON W4 ■■■ • . ■.......... 0 ■■ N . .■■■■ ■■ ■ ■■..MMMMEM M MEMO OMEN NMI MEN MEMO M I■ �� ■ ■ ■ ��■ ■ _ . Application Accepted Final Inspection By Character of Soll to Depth of 3 COMMENTS Fax{lore ofsys N AF_PART 4NA Datea / � ,�y%t%�/t Area � qq Employee IDtk btt Date a iv Lv rSPECIAL PERMIT - Approved by — PitlSUmp Soil C aracter. r7 PE SC Received 'Zhock#V Amount PermiV Code INFO By ZNTI— Remitted Date Invoice # Permit ID# Service Re uest # la r ►� t, 4:-07 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114116