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ONSITE 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 209 953-7697 FOR INSPECTIONS <br /> �1� EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 7/i S }lJ �✓��� �U�vc:. CITY/ZIP <br /> CROSS STREET �.�L�,�� APN 0,07a 6-0 y$ PARCEL SIZE WC/.?. o <br /> OWNER NAME ��'v.P J T J ��'r O Ya�l/�S PHONE WO- S33s <br /> ,pr m <br /> OWNER ADDRESS ��'�F►'fl_ CITY/STATE/ZIP <br /> CONTRACTOR �t-y� nL f4/J�c �r//Jf� _ PHONE <br /> CONTRACTOR ADDRESS 37y� {yGGl.�iis �i /� .�/� CITY/STATE/ZIP <br /> LICENSE 11/Z-42 111-IC-36 OTHER NUMBER EXPIRATION DATE 4"P <br /> WATER TABLE DEPTH: i S V ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> G PERC TEST # BUILDING PER # LAND USE APPLICATION# <br /> TYPE OF WORK: I NEW INSTALLATION tai1r. fJ REPAIR/ADDITION ENGINEER DESIGNED/ LTERNATIVE <br /> REPLACEMENT IP�L�'.: OUT-OF-SERVICE SEPTIC SYSTEM h DESTRUCTION kjjAr <br /> INSTALLATION WILL SERVE: 9,RESIDENCE E COMMERCIAL E OTHER <br /> NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: �1' �' NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFGG CAPACITY ftc�� gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL so ft FOUNDATION '30 ft PROPERTY LINE Y' ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES _ LENGTH OF LINES !;S ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 14V" ft PROPERTY LINE 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 NEAREST WELL ft FOUNDATION ft PROPERTYLINEft <br /> SEEPAGE PITS NUMBER 3 WIDTH ft DEPTH / 7 ft <br /> DISTANCE TO NEAREST WELL �O +` ft FOUNDATION ft PROPERTY LINE S , 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED f� --� TITLE- DATE <br /> Njo <br /> Hyp Vj IN <br /> r <br /> M <br /> DEPARTMENT USE ONLY ;1 9 <br /> Application Accepted BDate :) Employee lD# -DA <br /> Area <br /> Final Inspection By Date C SPECIAL PERMIT-Approved by <br /> Character of Soil to Dept of 3 Ft: PIt/Sump Soil Character: -rt- <br /> COMMENTS Re-�041,}01t; 57k5—Eekv, -Fof ren?,d l d exa;b�� _ees,rlerce, /)er <br /> PE Sc Received wiftaw Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 2ORV 4300 2 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />