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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOACUIN 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 ZQ ;Z t4_A,2 n je i/,,r CITY/ZIP �t�///�/lf/1J L S�,[ � u` _r <br /> CROSSSTREET �?21 �1/ APA�1-"� a�- PARCEL SIZE 1r lv - <br /> OWNERNAME ��, (% (*/ /�y L� PHONE 1 <br /> OWNER ADDRESS J ','A_e/ n L CITYISTATEIZIP } ) J <br /> CONTRACTOR i/H,„b�./fit' /"[x =mak J C/,YG PHONE <br /> CONTRACTOR ADDRESS /n F 7 // 1�/� `-, /J CITY/STATE/ZIP /� <br /> LICENSE ❑-C-42 ❑-C-36 OTHER / ' NUMBER C z-;;2J EXPIRATION DATE-3S)-�(! <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# ' I f LAND USE APPLICATION# <br /> TYPE OF WORK: D NEW INSTALLATION 0 REPAIRIADDITION LI ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT O OUT-OF-SERVICE SEPTIC SYSTEM 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL OTHER .S <br /> NUMBER OF LIVING UNITS: )) NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES' _ <br /> SEPTIC TANK TYPE/MFG �J'j 4-� 40,- CAPACITY /Z� gal #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG �� CAPACITY ]al #OF COMPARTMENTS 1 <br /> DISTANCE TO NEAREST: WELL / �i' FOUNDATION 5 '-F ft PROPERTY LINEJT ft <br /> ElLIFT STATION SIZE TYPE OF PUMP i,� C3PKG TX PLANT 13 SAND OIL SEPARATOR(ENCLOSED <br /> SYSTEM) <br /> YX LEACH LINES LEACHING CHAMBERS j�y tQ #of LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL/!/%Q It FOUNDATION J�� ft PROPERTY LINE l / It <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSALPONDS WIDTH It LENGTH ft DEPTH ft,..�r DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1� <br /> U `SEEPAGE PITS NUMBER WIDTH 3 h DEPTH 2-5 / ft <br /> DISTANCE TO NEAREST WELL /!�i It FOUNDATION /�J 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 /> AlINIM&M 48 HOUP-ADMNCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED " - - TITLE �i/ U DATE <br /> RFq yMF <br /> *4?0 qy0O <br /> �i q QCq O� <br /> wrk <br /> I MFNT <br /> I <br /> / DEPA RTMENTU EONLY n <br /> Application Accepted L'L Date Zv�J Area -� (.� Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-AFProved by <br /> Character of Soil to Depth cf 3 Ft: PiVSump Soil Character: <br /> COMMENTSff:T� (moi licrW sho(�: j It'f �, �"06, 0r1)tr <br /> PE SC Received I Check#/ Amount Date PermiU Invoice# Permit lD# <br /> Code INFO sh Remitted Service Re uest# <br /> L1,2I1 ►I7 I. ; <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br /> f 4�68124�, <br /> Scanned with CamScanner <br />