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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 I_ _ CALL 209)953-7697 FOR INSPECTIONS EXP/IR/ES I YEAR FROM DATE ISSUED <br /> 64 <br /> JOB ADDRESS ���J CJ 7G✓I SiON (� �. CITY/ZIP <br /> '/ <br /> LL��c / �� ar <br /> CROSS STREET XTN <br /> � .S/O�t Cf• /\Pii � (�I �T��y PARCEL SIZE <br /> rid <br /> OWNER NAME OY2vrQP_ ��<< SI PHONE CA <br /> OWNER ADDRESS CITY/STATE/ZIP /- <br /> CONTRACTOR w"e / l/ I�/'% "'�9/ PHONE '10o <br /> CONTRACTOR ADDRESS `� 0/5aN OY• CITY/STATE/ZIP (-/0 <br /> LICENSE ❑4-42 ❑❑C-36 OTHER NUMBER 75 fV 4:-C EXPIRATION DATE <br /> WATER TABLE DEPTH' " to ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION LI ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT 0 OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: r NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG �('�S� 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 ❑ LEACHING CHAMBERS #OF LINES � LENGTH OF LINES `7B ft <br /> DISTANCE TO NEAREST WELL70 f ft FOUNDATION �S ft PROPERTY LINE 5 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 /> I \ DISTANCE TO NEAREST WELL 0 ft FOUNDATION 3o ' 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL L2092953-7697 <br /> SIGNED TITLE 9C DATEAl I <br /> CO <br /> 45 <br /> h / N <br /> E T Nry <br /> T <br /> EPARTME T SE YN.LY <br /> Application Accepted BX01 Date Area Employee 14# <br /> Final Inspection By Date a 9 ❑ SPE IAL PERMIT-Approved by <br /> Character of Soil t 4th of 3 Ft: Pi Sump Soil Character: <br /> COMMENTSl G * <br /> PE SC Received heck#/ Amount Permit/ <br /> Code INFO B a h Remitted Date Service Request# Invoice# Permit ID# <br /> Illy!TeA 58008 13 15 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />