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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-1209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS ExPPIRES 1 YEAR FROM DATE ISSUED <br /> p <br /> JOB ADDRESS V CITY/ZIP l o 3 Z� <br /> -7 S J*C <br /> CROSS STREET E <08e/I, ,��Jf�,�. {{�� ���y� Ali OQ/r'9 3y3� PARCC�EL SIZE <br /> IZZE <br /> OWNER NAME ar't aid SAW If I W I PHONE 2D( _J2,7- 4192-7 <br /> OWNER ADDRESS 25 ;so p n And ltzw / , � �y CITY/STATE/ZIIPp� Gt�p��hGY� 2 3 7- <br /> CONTRACTOR ` Y 1 �LZI1C�y `�/ V�G 0 )VL li(/1��S 1 '&k fi HONE 2,0J Z�I�/ � 572, ✓ <br /> CONTRACTOR ADDRESS ���� UZJV`�� CITY/STATE/ZIP !/l/�l L� <br /> LICENSE ❑ C-42 Fli C-36 DITHER I`t,C NUMBER 07 ✓`���EXPIRATION DATE <br /> WATER TABLE DEPTH: ISS ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: I NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> x REPLACEMENT /f4 Lli I� I OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: I 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: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> t LEACH LINES I LEACHING CHAMBERS #OF LINES LENGTH OF LINES h b ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION b�n ft PROPERTY LINE �L� / 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 NEARST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER WIDTH ) ft DEPTH -Ij l`:� ft <br /> DISTANCE T EAREST WELL!�� ft FOUNDATION Z(" ft PROPERTY LINE^ ft <br /> I HEREBY CERTIFY THAT 1 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 /> MN/M M UQI ADVAIVCENOTICE R UIRED FOR INSPECTIONS-PLEASE CALL 20 953-766997 <br /> SIGNED TITLE DATE <br /> Ir/ Ll <br /> GAN KIAUN <br /> 0 <br /> liL 1411 Q It I L LF RFt• <br /> Al PF-41V I F <br /> 1 <br /> DEPARTMENT USE ONLY <br /> Application Accepted B 1��, Date 71121,qoaq Area -!% EmPAIi DA <br /> Final Inspection By DatePECIAL PERMIT-A% �� <br /> Character of Soil to Dept of 3 Ft: Pit/Sump Soil C racter: <br /> COMMENTS c,..1 u t 6f �I .J fpr Clnl( s orae e OD <br /> F1f 'n�4:h gleyIihS, l _ t FYIB ' ' SAMo�0 <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO By Cash Remitted Date Service Eequest# Invoice# Ait Ili <br /> 117 <br /> on ,fw'a}"n <br /> 42-011Io pl+h I�/� I'C � E WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br /> +"'�4 <br />