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( DNS@- E VVASTEWA ER TREATMENT EN SYSTEM PERWT1 <br /> SAN JP dIUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> KION-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS All ./0e, CITY/ZIP Z - <br /> L' <br /> CROSS STREET T j61;' ,Q12 APN o sa iaa 1 PARCEL SIZE= �1 <br /> ��� 21/1� <br /> OWNER NAME / i /d� PHONE /' <br /> OWNER ADDRESS Ps-'N,, P,dqf� Ave -4110 CITY/STATEIZIP (A <br /> ��w <br /> CONTRACTOR ���i //,1/(� / LJl?/(/A� � >L�.LiI - PHONE D� SI �Ja <br /> � f <br /> CONTRACTOR ADDRESS �� _;Z _e� CITY/STATE/ZIP StVgG ,P <br /> LICENSE ❑LIC-42 ❑LIC-36 OTHER NUMBER._g!;�2:70-gEXPIRATION DATE - 2 _0&f-'Z6 <br /> WATER TABLE DEPTH:_HS ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# K f—I bSa SS- LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> L REPLACEMENT n OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: S2ESIDENCE ❑ COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG z�z CAPACITY �e2 gal #OF COMPARTMENTS l <br /> U GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL���jJ J ft FOUNDATION 7� ft PROPERTY LINE �J ft <br /> © LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT El SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> AL LEACH LINES ❑ LEACHING CHAMBERS #OF LINES _ LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL /lib ft FOUNDATION /0 '4 ft PROPERTY LINE. �� ft <br /> U FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> C2 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> CEJ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> C7J DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL / ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER lJ WIDTH �7' > ft DEPTH ;i-5- > ft <br /> DISTANCE TO NEAREST WELL �S�� ft FOUNDATION 1012- ft PROPERTY LINE 5.- � 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 /> MINUUM 48 HOUR,,ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br /> SIGNE TITLE DATE — <br /> 8,9 Ar <br /> U <br /> E <br /> DEPARTMENT USE ONLY Zn� / y 9 D <br /> Application Accepted By Date 3 aoao Area Employee yee ID# A <br /> Final Inspection By MA Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to De h of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS Pj(-W S f- - )P✓ IT <br /> PE Sc Received hec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B as Remitted Service Request# <br /> ya I I ► �7 2, (D <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />