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r <br /> ONSITE WASTEWATER TREA`���dEV�9�` SYSTEM �f�:Ci�.N�� 1� <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 CITY/ZIP ! `��'G.Y' <br /> CROSS STREET APN — 6L+ �g PARCEL SIZE ? n <br /> n 1 d <br /> OWNER NAMEr i4c_'(4 If !f &W-A A PHONE rhn <br /> Cn <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR_ , �:�G(Lll�uti � PHONE_ q&& - <br /> CONTRACTOR ADDRESS ��( � b CITY/STATE/ZIP /)I,=A i-Cr;� <br /> LICENSE ❑❑C-42 ❑❑C-36 OTHER NUMBERkkS7514 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 ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALT RNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION She <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: /� NUMBER OF BEDROOMS:,.? NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG r J-1- CAPACITY 1 'a a gal #OF COMPARTMENTS_ <br /> ® GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL 1 56C ft FOUNDATION ft t ft PROPERTY LINE ` 4 t ft <br /> ® LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> � L y 67 � <br /> LEACH LINES ❑ LEACHING CHAMBERS t'�'r(I l rk i M #of LINES LENGTH OF LINEs ft <br /> e <br /> DISTANCE TO NEAREST WELL 'hDt ft FOUNDATION W' ft PROPERTY LINE I ft <br /> Q 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 /> E3 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 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 AL ANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL 209 953-7697 <br /> SIGNED TITLE C15Aikyeh f` DATE 3 <br /> PA <br /> 21� lit <br /> IV <br /> N CO <br /> L <br /> N <br /> DEPARTMENT USE ONLY �+ I <br /> Application Accepted � -A,By Date ,-T CZV Area r 7 Employee ID# ��✓✓�Y <br /> Final Inspection By AzzdDate ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS �Pw�4' .01d. Mgo i �lonrnt� syph- �o;woc r f �,�t�3�/, sPpF�t a�C--hr <br /> .o,yne%�ed. OWTS pjjt1 c.' ��,x�Mu►•�'oICQ}h of d� 'nihe.s as ver ]NL.S ��I//ef r claim/ 716�1�f <br /> o/d !� •fit /�An�G a*n eek 6° .6k e er 4 aro N' - �-Z--LQ <br /> PE SC Received Chec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Re uest# <br /> tai I07sgy 3 'zs 4D <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />