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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 209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 6 hh 2 CITY/ZIP <br /> CROSS STREET ArozoGni APN V / �l I PARCEL SIZE ♦� b <br /> OWNER NAMEPAP 1 fG1,Vt v PHONE <br /> VIJ Qr �� <br /> z <br /> OWNER ADDRESS L010 4Jfr}f" , CITY/STATE/ZIP yy✓G""' �� i/�/A s- <br /> CONTRACTOR [aG1 �y <br /> 4hl ( 1,�/C� PHONE D"'% ^� ` � <br /> CONTRACTOR ADDRESS 6o CITY/STATE/ZIP "� G <br /> LICENSE EJ C-42 ❑I iC-36 OTHER NUMBER TS7�75 EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # ®UILDING 9'ERMIT# LAND USE APPLICATION I# <br /> TYPE OF WORK: C NEW INSTALLATION REPAIR/ADDITION L. ENGINEER DESIGNED/ALTERNATIVE <br /> l.' REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM ! DESTRUCTION <br /> INSTALLATION WILL SERVE: CI RESIDENCE 1_1 COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: �" NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> E3 SEPTIC TANK TYPE/MFG �X/s�i-GL. CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE_ TYPE OF PUMP © PKG TX PLANT Q SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES '/O ft <br /> / r <br /> DISTANCE TO NEAREST WELL � J90ft FOUNDATION 60 ft PROPERTY LINE �p70 ft <br /> ® FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL 7 ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER (; WIDTH J ft <br /> / ft DEPTH e S ' <br /> DISTANCE TO NEAREST WELL D ft FOUNDATION /–?0 ft PROPERTY LINE �p�0 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 /> MINIMUM 48 HOUR ADVANCENOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE� DATEfez <br /> 0*9 <br /> Jq <br /> R <br /> t <br /> �D PARTMENT S Y <br /> Application Accepted By -- — - DateSVR"—( Area -�4-i� =�— Employee ID# <br /> - - - <br /> Final Inspection By Date S ❑ SPECIA f ERIVIIT-Approved by <br /> Character of Soil to epth of 3 t: - _ _ Pit/Sump Soil Character: /►')� 0 n <br /> CONIMENTS%!ef. �- l -- Alit) MgU7 --� - SIL Iii f� <br /> oI/a r <br /> I PE Sc Received eck#/ Amount Permit! <br /> Code INFO By — emitt Date Service Re uest# invoice# Permit ID# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />