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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 NON-REFUNDABLE PERMIT — CALL(209 953-,7&97 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED _._._ . ._... JOB ADDRESS aj-xy� J]� ^� CIn17JP�fnmLb CROSS STREET l > -0,�lL--�D __ APN f,�/'�� 37 -- PARCEL SIZE R OWNER NAMF. /g�w_ {��Ji.�L�'�,_,,.,_-,�U/VKI J PHONE OWNER ADDRESS 1"'-'r{� / CITYISTATFJ74P CONTRACTOR_ �_.� 7I/�y.,- c' tC T_PHONE / CONTRACTOR ADDRESS 3 T Ja / � CITY/STATEIZiP LICENSE IL PC-42 ❑i:IC36 OTHER NUMBER -EXPIRATION DATE-OS�30/.'I I WATER TABLE DEPTH: V It GEOGRAPHICAL INFORMATION: Coordinates X Y FERC TEST # BUILDING PERMIT# DDS NO USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADOITION - i" ENGINEER DESIGNED 1ALTERNAT� ij REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I'. DESTRUCTION INSTALLATION WILL SERVE: 1t ResMemCe C! COMMERCIAL ['.I OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 16 SEPTIC TANK TYPE/MFG !�L CAPACITY--Z;r -- gal #OF COMPARTMENTS �z ❑ GREASE TRAP TYPE)MFG 7_- CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL f00' ft FOUNDATION s _ it PROPERTY LINE 50' R ❑ LIFT STATION SIZE TYPE OF PUMP_ ❑ PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) ........._,_......... _._._ _ .._.........._ .._......... . _ .. .. ....... _...._ ...... ..................... Pik, LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES SS" h DISTANCE TO NEAREST WELL J!5740 it FOUNDATION ZO ft PROPERTY LINE S7J ft ❑ FILTER BED WIDTH _ft LENGTH It DEPTH ti DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft ❑ MOUNDED WIDTH_ ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION it PROPERTY LINE ft ❑ SUMPS WIDTH it LENGTH ft DEPT+-I ft DISTANCE TD NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH_- _ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL--It FOUNDATION ft PROPERTY LINE. it A2--'SEEPAGE PITS NUMBER I WIDTH_._y�' ft DEPTt9 PS-' It DISTANCE TD NEAREST WELL/5-0, ft FOUNDATION t;C) ft PROPERTY LINE eZ it I 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. 4 l A Y (yCE NOTICE REQUIRED FOR/NSPEC//TION//S-PLEASE CALL(209)953-7697 SIGNED TITLE larl/X/�rf�!_ DATE - - - E — - M EPARTMENT SE NLY Application Accept+1) Date Area i Employee ID#- JK Final Inspection ByDate (I SPECIAL PERMIT-Approved by Character of Soil tof 3 Ft:-,_-„ ^, P Sump Soil Character: COMMENTS �-- &tA- 0 1' $IgA2 14 JAW yt&A-00'I xl -.--off fwv _ ---- - ......................_ ... _... ...... ._ _ _ . .....-._. _ PE —SC Received Amount Data— PermN Invoice# Permit ID# Code_ INFO_ By _ h _ Remitted — W Servica.Re uest# ! g 42A1 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114118