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r *% <br /> NSA"ISE WASTEWATER TREAMCEE T SYST M �( <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 05- 2020 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 77Rrg /yl�e �Kf / CITY/ZIP JS-�P1� G <br /> CROSS STREET L'� <br /> ���tiJ/- APN ��II 7 6 PARCEL SIZE <br /> OWNER NAME ��JVO/C = PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR eel, 1411111 —<17 PHONE <br /> CONTRACTOR ADDRESS �. .�i�. CITY/STATE/ZIPCI�Lw <br /> LICENSE ❑CSE-42 ❑OC-36 OTHER NUMBER ys�l /� EXPIRATION DATE 6 <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 ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: Rl�'RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: (� // NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG jjK/C. 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 /> P�- LEACH LINES ❑ LEACHING CHAMBERS #OF LINES�_ LENGTH OF LINES VSs ft <br /> DISTANCE TO NEAREST WELL IlieJ ft FOUNDATION D 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 ftFOUNDATION ft PROPERTY LINE ft <br /> �— SEEPAGE PITS NUMBER WIDTH ���r ft DEPTH r�� ft <br /> DISTANCE TO NEAREST WELL_,/ro ft FOUNDATION A0 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 209 953-7697 <br /> SIGNED TITLE DATE ZO <br /> C.FEE <br /> Aft <br /> ppR <br /> l DEPARTMENT USE ONLY <br /> Application Accepted /1 DateR -7'7 7,JZO Area "1�'1 Employee ID# ter! <br /> Final Inspection By Date hera ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft Pi Sump Soil Character: <br /> COMMENTS Le601 Line Cc jjoye , 'P,i <ys�k-m- <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Cash Remitted Service rAquest# <br /> `1a la 1►S 23 Z 43aa <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />