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1 <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL L209)953-769 FORINSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS _ m-, 86 Oil- <br /> G GJ <br /> CROSS STREET -< OG /w.0 `—47 APN Vilma 07 O � PARCELSIg _ �y <br /> OWNER NAME IJ 1 `�S7•C (� - PHDNE Fly�l' -55#'� <br /> OWNER ADDRESS _CITY/SfATEMPPXQ J /yy ^�7 <br /> CONTRACTOR fevrkpl Vew11w w }L�� PHONE-.29-9- ( -S�op <br /> CONTRACTOR ADDRESS e-P. �SO// A// i / CITY/STATE/ZIP Q ]/ t4 9�Jz <br /> LICENSE �-42 C-36 OTHER NUMBER )�D S EXPIRATION DATE / ✓�_/ / <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDrnON ENGINEER DESIGNED/A TERNATI VE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS:_ UMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPNMFG L CAPACITY A;too gal #OF COMPARTMENTS_" <br /> GREASETRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ✓ <br /> DISTANCE TO NEAREST: WELL /C I ft FOUNDATION I� ft PROPERTYLINE .10 It <br /> LJ LIFT STATION SIZE_ TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> XLEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL 1 C It FOUNDATION 142 ' ft PROPERTY UNE _ ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft Y AM E NT <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH <br /> DISTANCE TO NEARwr WELL ft FOUNDATKX4 ft PROPERTY UNE E Cy,:. ea�gp E A C E D <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE RSI,, <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> x <br /> DISTANCE TO IN AREST WELL 't ft FOUNDATION ft PROPERTY UN g <br /> SEEPAGE PITS NUMBERWIDTH Tpft DEPTH ft JVIRONM ENTAL` ENVIRONMENTAL <br /> DISTANCE TO NEAREST WELL4� PROPERLINE/, _ T�ENTjkALTH � <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> `v STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 9 <br /> MINIMUM 48 HOUR ADM&"NOTICE REQUIRED FOR INSEECTINS-29ASE CALL 1209J 953-7697 <br /> SIGNED TITLE <br /> IL <br /> 1 <br /> 11 rD PARTMENT U E NLY Y�J /� <br /> Appflcatlon Accepted By Date Area Empoyee ID#T V _ <br /> Final Inspection By Date I SPEC PURi -Approved by l <br /> Character of Soil to De h o 3 Ft: wit/S.6 Soil Character: <br /> COMMENTS 4ko- <br /> �� <br /> F-PE--F SC Received Check#/ Amount Date PerrnlV invoice# Permit IDX <br /> Cod IN Cash Remitted ervice R uest X <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />