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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)953-76997 FOR INSPECTIONS T EXPIRES 1YEAR <br /> �FROM DATE ISSUED <br /> JOB ADDRESS `I�C)� uI }-�-1G^1-1V�lrpY L► CITY/ZIPG /� <br /> �y� <br /> A "l6-/`4rL v <br /> CROSS STREET APN O CJ�O" I �' PARCEL SIZE p <br /> OWNER NAME STDGkTIS N fl E L?A lett.`.SbR.T L-L-G PHONE (LP-4-e->&-15-1.5 J� m <br /> A /� ( ``, �/ n <br /> OWNER ADDRESS 1 A- dD WV H j` w _Y� 1 0"y CITY/STATE/ZIP L&PQ i `tea 'fr <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE Eli C-42 ❑ C-36 OTHER NUMBER EXPIRATION DATT�E,Q n <br /> WATER TABLE DEPTH: . ' � •e2, ft GEOGRAPHICAL INFORMATION: Coordinates X 6(e 84{ Y <br /> ,�- PERC TEST BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: i NEW INSTALLATION REPAIR/ADDITION I I ENGINEER DESIGNED/ALTERNATIVE <br /> I REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELLft FOUNDATION ft PROPERTY LINE ft <br /> LIFT STATION SIZE !10 ML TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> pi-m96 --- -- - _ I _ __- ._ - ---- -- <br /> ❑ LEACH LINES 1 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 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 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CER:24k1HDUR149VANQ <br /> T 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 /> MININOTICEREQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED IM" TITLEOGVNk-__& 9EY9 DATE <br /> ul <br /> 120— <br /> VdDA <br /> E IRN SIV <br /> 4:FFT <br /> DEPARTMENT USE ONLY <br /> Application Accepted B e= LZ' Date /S- .�D:O Area Employee ID# D^I <br /> Final Inspection By Ilkly-41Date �—/S' ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sum Soil Character: <br /> COMMENTS t G� ^ l {� f vsa..� �� <br /> kip 1 � �t�4.,n- ✓i��c-� w �! �h �e�- �� <br /> PE SC Received Che c # Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO s Remitted Service Request# <br /> Ndl a51 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/16 <br />