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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 L e e fl �� CITY/ZIP 15:4,11 <br /> CROSS STREET A" � APN (ly ]��I �/ U � PARCEL SIZE ry-7 <br /> OWNER NAME 0- PHONE �Gy- OS3 <br /> OWNER ADDRESS/ So,v,-e � CITY/STATE/ZIP/ <br /> CONTRACTOR LeY!/721�L Lam'✓//w <- C_ PHONE <br /> CONTRACTOR ADDRESS 32eb 2o,,IL tZe- CITY/STATE/ZIP Sr�b <br /> LICENSE ❑ 42 11 IC-36 OTHER NUMBER '7 S V Y? 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 I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER / <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 21 SEPTIC TANK TYPE/MFG / )Gy 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 /> EACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES �1L� r ft <br /> DISTANCE TO NEAREST WELL 16) ! ft FOUNDATION sz 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 _6/' ft DEPTH 25�' ft <br /> DISTANCE TO NEAREST WELL Ste— ft FOUNDATION 10 ft PROPERTY LINE ?L 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 HQUR ADV N E NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL 209 953-76 7 <br /> SIGNED TITLEDATE /y <br /> In <br /> ON <br /> A U/ <br /> 1 71 <br /> rF <br /> DEPARTMENT USE ONLY <br /> Application Accepted LaZDate Area Employee ID#� <br /> Final Inspection By Date 1 Z ❑ SPE I L PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: it/ ump Soil Character: <br /> COMMENTS <br /> PE Sc Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> O <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />