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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 2r009)953-7697 FOR INSPECTIONS ��E�X/PIIRRE'Sf 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS l 'SLA 1 l Cb'A /j CITU/ZIP lK-f'-1�N -( zo� <br /> CROSS STREET �O'�1{C�-rKy d` f ��Q,,�� r .�-,1(� APN I� J-C�q- D7� /PARCEL SIZE <br /> T�jp ''j �J p <br /> OWNER NAME 1 IL�I�fT(V 1-�`�"�V`c—,c T-6%I IBJL �tAC� —PHONE <br /> (�fC� JO ' I��/4 <br /> OWNER ADDRESS <br /> � �I FO �/�LC` � I n L' ,.�.y `.fin`' ��(� CITY/STATE/ZIP &�qL \I(J`A <br /> CONTRACTOR 1'101.1 A /AM�((AJ-t .��p ,N(rt/�l. ✓.�l/7+y(S''L7 J PHONE �g6 1M) <br /> CONTRACTOR ADDRESS 4,713 C:J I .TPRfli UJt'� t ✓VIM 1 CITY/STATEIZIP IDLL�Iy ✓/` ! �y(O <br /> LICENSE _...C42 C-36 OTHER NUMBER 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/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT _ OUT-0FSERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: _ RESIDENCE I] COMMERCIAL _. OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG 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 ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LNCNING CHAMBERS /FOATION_ft <br /> ES� LENGTH OF LINES t D ft <br /> DISTANCE TO NEA WELL ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LEND ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft OUDATIO Nft PROPERTY LINE It <br /> E3 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft --PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENG ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft ENGTH ft DEPTH DA flAEiVT <br /> DISTANCE TO NEAREST ELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER y WIDTH ft DEPTH C EIVED <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> t HEREBY CERTIFY THAT I HAVE PREPARLb THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINAN,. .1G 0 5 ZOi9 <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697SAN JOA UIN COUNTY <br /> SIGNED TITLE DATE ENV ONMENTAL <br /> TV <br /> DEPARTMENT <br /> PARTMENT SEONLY <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By Date G SPVCIAL PERMIT-Approved by <br /> Character of Soil t Depth of 3 Ft: Pit/Su/mp Soil Character: <br /> COMMENTS �� ISA cGi <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />