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ONS11 E 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 9'53-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Q n G2 <br /> r).'n ¢Eoaq< CITY/ZIP S-F�jc 4 nT n <br /> �I Q (/�� <br /> CROSS STREET �' !/� APOA 3D PARCEL SIZE p <br /> /fib <br /> OWNER NAME �enS ,, �JQrO `/ �J PHONE y <br /> OWNER ADDRESS CITYISTATEIZIP <br /> CONTRACTOR r rLt� l�4(xa-e- 5`f- PHONE <br /> CONTRACTOR ADDRESS P2 ����yy.��� _CITY/STATEIZIP <br /> ❑ <br /> LICENSE LIC-42 Ell-IC-36 OTHER NUMBERGOVS-s-r EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # I I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: C NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> Li REPLACEMENT n OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: ✓ NUMBER OF EMPLOYEES: <br /> U SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> U 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 Q SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> � I <br /> 2 LEACH LINES ❑ LEACHING CHAMBERS #OF LINES / LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL � rr ft FOUNDATION (V t ft PROPERTY LINE, to ft <br /> ® FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 MOUNDED WIDTH ft LENGTH_ ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> CSI 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 3r--t% ft DEPTH 21t r ft <br /> DISTANCE TO NEAREST WELL (jh( ft FOUNDATION r _ft PROPERTY LINE 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 48 H UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 9/53-7697 ^ _ <br /> SIGNED r j TITLE COY` DATE 3-e-) Ga-c1 <br /> 5 . J A IN GO INTY <br /> —1'-:NVII C PAR4 L H I.A T, ez 5A <br /> ITA <br /> / O <br /> DEPARTMENT USIE ONLY (� <br /> Application Accepted By Li�� Date �a 30 a b Area / Employee ID# bA <br /> Final Inspection By �UkxaPuy Date 2028 PECIAL PERMIT-Approved by JzOTA <br /> Character of Soil to De th of 3 Ft: Pit/Sump Soil aracter: <br /> COMMENTS �ai��ie lees. i 1� 10f IS�in s S ecla errNi� pr <br /> F n0I `i-. Per k nq t ,�k H 100 <br /> ells Q4K I Qf14i)7&11V0n It '/g ;, <br /> PE SC Received iec Amount Date Permit/ Invoice# Permit ID# <br /> Codej INFO By ash Remitted Service Request# <br /> Kala pis X300 x.30. (Z 00 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />