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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAzELToN AvENUE-STOCKTON CA 95205-(209)458-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1051 Robert Ave Crn'1ZIP Ripon 95366 <br /> ��yy nn n <br /> CROSS STREET 7th St APN ! S"I Ovl oo7 PARCEL SIZE 1.3 acres o <br /> d <br /> OWNER NAME Todd Ah Yo PHONE 209 456-0119 <br /> OWNER ADDRESS 1051 Robert Ave CITY/STATE/ZIP Ripon,Ca 95366 <br /> CONTRACTOR Owner/Builder PHONE <br /> CONTRACTOR ADDRESS Same 7, CITY/STATEIZIP <br /> LICENSE ❑i 1C-42 ❑i 1C-36 OTHER B-1 NUMBER 765059 EXPIRATioh DATE 6/30121 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> EPERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 11 NEW INSTALLATION „ REPAWADDITION ENGINEER DESIGNED IALTFRNATNE <br /> ? REPLACEMENTOUT-OF.SERVICESEP7ICSYS7EM DESTRUCTION �antlonment �j�r ►- <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ' COMMERCIAL U OTHER ,- <br /> NUMBER OF LIVING KNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> VSEPTIC TANK TYPE/MFG LL M V-- 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 /> ❑ LEACH LINES i 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 n ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE_ ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH Re VIC <br /> f1T <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE D <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH Am 4 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY L1IYA IVij ft <br /> E3DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH 9 4 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY U L771„NMENr,NtY <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH RTMEn,jE <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WrrH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MLAWqMA2&tgQR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE `V W Aj DATE I I <br /> -- <br /> OL N:jw <br /> a <br /> 777 1 <br /> I I-T I j.=7r7I—T-7I I 1_=r-17—E= <br /> DEPARTMENT USE ONLY QI L <br /> Application Accepted y ��! !✓L✓ Date /q1 ,fit Area 9I Okl Employee ID# SK <br /> Final Inspection By Date oZ VZV ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth 3 Ft: _ Pit/SU np Soil C aractel�� <br /> COMMENTS V QiYI �. �Q$`Gi!(•t,C <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO BCash Remitted Service Re u t# <br /> y I 07$- _ ►sa �7 - <br /> 4POYme" ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />