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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 /> Joe ADDRESS / J i`G''�7�7 r /t�'l-1 Cm21P.�' ,-� g l q 5�1;7Lr v. <br /> CROSS STREET /n-S /t� �T '//L/��/// APN 08906064 PARCEL SIZZE�j 712/.30 <br /> OWNER NAME / /V ,) <br /> �[ PHONE'2.r7 <br /> �4 i <br /> OWNER ADDRESS <IAXA CITY/STATE/ZIP <br /> CONTRACTOR x,� /f/S FV I,y1� E,(-/ PHONE 'L,6 q t9. I <br /> CONTRACTOR ADDRESS rr''// _CITYISTATE/ZIP <br /> LICENSE ❑EC-42 OCC-36 OTHER NUMBER C�C //�C» EXPIRATION DATE �✓) i r'2ci <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: U NEW INSTALLATION REPAIRIADDITION L1 ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT C, OUT-OF-SERVICE SEPTIC SYSTEM 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: TR RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: - NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> /;� LEACH LINES G LEACHING CHAMBERS #OF LINES_/- LENGTH OF LINES-R <br /> / DISTANCE TO NEAREST WELL /f]O�-)•- ft FOUNDATION /ZZ';f__ft PROPERTY LINE it <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> 24 SUMPS WIDTH ;2- � R LENGTH /I— R DEPTH '�' r— <br /> DISTANCETONEAREST WELL S 2i•ft FOUNDATION l/J',L- ft PROPERTY LINE���- ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE it <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTYLINE It <br /> 1 HEREBY CERTIFY THAT]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 /> REQUIRED Fog INSPECTIONS PLEASE CALL2 <br /> SIGNED TITLE C?�--2 __ DATE <br /> ------------ <br /> --------------- <br /> RE YMFN <br /> --------------- <br /> N,,o AP <br /> R 20 ?020 <br /> A h DNMFNOUNTY <br /> FpgR7-A <br /> DEPARTMENTUSEONLY <br /> Application Accepted B :;esar Ruvaloeba Date 4120/2020 Area Employee ID# SK <br /> Final Inspection By Date All ElSPECIAL PERMIT-Approved by <br /> Character of Sol]toDepthDepth o� Pitl ump Soil Character: <br /> COMMENTS ed. <br /> I Ir.l,.,..wn reason fnr ..d.JI4inn Tier II u kUP w� 14 +%4 %M• 4,269' <br /> PE SC Received Check#/ Amount Date Perm Invoice# Permit ID# <br /> Code INFO Cesh Remitted Service Request III <br /> 4210 115Z1,54-.. 300 <v SR0081991 <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114:19 <br /> Scanned with CamScanner <br />