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ONSITE WASTEWATER TREATMENT SYSTEM V ER6h HT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT /j �/ CAL}L� 209) 953-7697 FOR INSPECTIONS / / <br /> EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 9 //0 444 �� A 11�Q CITYIZIP 49 /; (A <br /> L G� r-� <br /> CROSS STREET CC• S loolle� � APN /C/ J 1 PARCEL SIZE O) O <br /> b <br /> OWNER NAME S- e A PHONEf,Ro,j)qg/ d�i37 Cn <br /> Q /' /j�r //-� <br /> OWNER ADDRESS 1�I.I�I� • At /IJr !.,��(� CITY/STATEIZIP W I '-,-2 L/0 <br /> CONTRACTOR �"� l 1/R PHONE C20 �cF �% �a <br /> CONTRACTOR ADDRESS � 7Y4 /"4! ' ��� ,/r CITY/STATE/ZIP <br /> LICENSE 0lN1 <br /> -42 ❑UC-36" OTHER NUMBER --EXPIRATION DATE <br /> WATER TABLE DEPTH: I 0 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: C NEW INSTALLATION X REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT Il OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: L NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> Q SEPTIC TANK TYPE/MFG '7 ti CAPACITY /O)C7 gal #OF COMPARTMENTS <br /> ® GREASE TRAP TYPE/MFG J 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 /> LEACH LINES ❑ LEACHING CHAMBERS F #OF LINES� LENGTH OF LINES I ft <br /> DISTANCE TO NEAREST WELL �J 0� ft FOUNDATION CLD r ft PROPERTY LINE d I 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 VEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER WIDTH -7 /1 ft DEPTH o95- 1 ft <br /> / DISTANCE TO AREST WELL 1f0� t ft FOUNDATION X00 ft PROPERTY LINE /00 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 448 HOURADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209)9/53-76997 <br /> SIGNED ;/G�S� � // TITLE t��l�l DATE <br /> Q <br /> A F_ <br /> i <br /> A U <br /> C E <br /> %jL 01F <br /> > DEPARTMENTEONLY <br /> Application Accepted B Date 0ab,a0 Area qlq'? Employee ID# DA <br /> Final Inspection By Date PECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Caracter: <br /> COMMENTS i UY J neS )sf , 6 / aoab Ch4n eCj - f.m ? yod i�S <br /> Cenlr<j <br /> PE SC Received Checic#/ Amount Permit/ <br /> Code INFO By as Remitted Date Service Reque t# Invoice# Permit ID# <br /> a l b i I s $ 3� �.�+ 2U <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />