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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL(2209)953-7697 FOR INSPECTIONS EXPIRES 1pYEAR FROM DATE ISSUED <br /> j <br /> JOB ADDRESS .7vS Ulk W U-r--y E-014 ", ST• CITYIZrI_P TE <br /> CROSS STREET K.JKSD APN 2 39- C)tYO PARCEL SIZE ,+r Ac• nbd <br /> OWNERNAME .Jll7Dr-F+P SJN&t+'+EyA PfzMIIn�-DE?. Y-ftu L PHONE (P4Q -11FO-0 <br /> OWNER ADDRESS <br /> 25"44-025"44-0 S. SC C V LT rE Il • CITYISTATEIZIP 'r tec.A q,f3.-�- <br /> CONTRACTOR L_jy E��Jfopty- GEoF-ajyi RONtmE,%rTYIL_ PHONE 3(D`I - ['�u� <br /> CONTRACTOR ADDRESS 40—+ W • Q' `�^ ST L <br /> CITY/STATEIZIP OO ( G1k � F+ -Lf0 <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # ( BUILDING PERMIT# LAND USE APPLICATION# i <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DE IGNED/ALTER ATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: O RESIDENCE ❑ 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 It FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 /> �IMU"HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 L <br /> SIGNED YvL TITLE w4SyLTArvT DATE 1(-2k-(. <br /> - -2 <br /> 2'X <br /> It <br /> 12'K 7s•mua tnDExr Eus 2]P-mo-22 <br /> TWIFA PMIm10 NOxfH 211]_110-12 m <br /> WAN E.TAIDO <br /> 2-2 <br /> 75' 0' <br /> ]5'K 20 A 2 WAIDFA <br /> \ SfON1 H1141 �(P <br /> �\ <br /> 21-- <br /> Ir x x•mucx "s'r°11rnos` > <br /> `\ .WYE 2RJOPKM2� �`� <br /> SITE LOCATION K33:0 <br /> PHOPoSED auul �\ t.' , �u°�'1xP05ET.x�¢(irr.) EAEDE�wcO-0ia�i ROTO <br /> uHx EE]0:E mv.)�4S�\,,'', ', ♦n xnn�cE(TMP.) uM-r`w�sor�+uc <br /> 2l9-OW-N <br /> 0 RROEIOC lW <br /> VICINITY MAP <br /> AEw DR _ <br /> -1-77 1 1 F0 1-7--F-I I 1 .1- 1 141 <br /> EPARTME T U E N <br /> Application Accepted By ate Area Employee ID# <br /> Final Inspection By Date ❑ $PE IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PiVSump Soil Character: MEN 1 <br /> COMMENTS v Itl <br /> RECEIVED <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# 28 2018 <br /> Code INFO B Cash Remitted S rviceRe uest# <br /> SAN AAQUIN COUNTY <br /> FN IRONMENTAL <br /> HEALTH DEPARTMENT <br /> 49-ni ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />