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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL <br />II EALTH DEPARTMENT <br />L4 <br />I J <br />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 (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS .24 (4, r) AI • KEN/Qc...4. 9-1) clryizip ACegvI.Po 9S- 2-2-o <br />CROSS STREET AC,pirlt,e 0 <br />APN On - l To -3 (9 PARCEL SIZE • s-e Pc - <br />OWNER NAME rtA W u 2- PHONE &L+2_ -S('7 <br />OWNER ADDRESS 5P5W1 CITY/STATE/21P <br />CONTRACTOR WE ()Al& CTEOEMrig01JME/Q-TAL., PHONE 312 - 031 <br />CONTRACTOR ADDRESS 440) Kr • o/\- k CA ci 2."-f0 <br />LICENSE QC-42 Elc-36 OTHER NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />X PERC TEST # <br /> <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: 0 NEW INSTALLATION 0 REPAIRJADDMON 0 ENGINEER DESIGNED /ALTERNATIVE <br />Ti REPLACEMENT 0 DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: CI RESIDENCE COMMERCIAL <br /> <br />0 OTHER <br /> <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 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES 0 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 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 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 />MINIML.I10 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED TITLE C.-dry\JA/L..-Th-rs..1 7- DATE CO I I - I cl <br />PAYMENT <br />..Mmt <br /> RECEIVED <br />JUN 1 8 2019 <br />a <br />.1 4 <br />Application Accepted By <br />Character of Soil to Depth of 3 Ft: <br /> Final Inspection By ▪ Date 0 SPECIAL PERMIT - Approved by <br /> Date <br />7"/O —..-8/EPARTMENT'US/E <br />fo, "qt5 <br />Pit/Sump Soil Character <br /> <br />7 Area <br /> <br />/qmployee ID# Arte-e_ <br />COMMENTS <br />PE SC <br />Code INFO <br />Received ChecIdt/ i Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />LF?? C7 g BdV )1' <br />Cas...714.1/, <br />1 C 1 c 7 . Lot iN' VI c I <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT :SS3LIGUY 311S