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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA95205-(209)468-3420 <br /> NON-REFUNDABLE 2PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS J�l J 1E .(S' '�� , 'S�Ap{` CITY21P_ fC L(�.�1..� <br /> CROSS STREET ,y ��l �y 1�(i� APN I V� tJ1 tJl V)Aj <br /> PARCEL SIZE <br /> C}�yr' �r�uy�r)IG� 1 <br /> OWNER NAME PHONE <br /> OWNER ADDRESS n CRY/STATElZIP <br /> CONTRACTOR L C'� 1� r'�} PHONE 26CI• <br /> CONTRACTOR ADDRESS 3 3 M U'A li l f. CRY/STATE/LP <br /> LICENSE ] C-42 -C-36 OTHER_ ?5 57 <br /> NUMBER I I EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PER #°'' a i'! LAND USE APPLICATION# t^�y <br /> TYPE OF WORK: NEW INSTALLATION T IVN ENGINEER DESIGNED/ALTERNATIVE `rA, <br /> REPLACEMENT OUT-OF-S RVICE SEPTIC SYSTEM ,y, DESTRUCTION <br /> INSTALLATION WILL SERVE: C RESIDENCE ] COMMERCIAL }CI OTHER y�_F^�nC'/I'►7P. r <br /> NUMBER OF LIVING G UNITS: � � NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> lid SEPTIC TANK TYPE/MFG ( CAPACITY at)() gal #OF COMPARTMENTS__ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELD_ ft FOUNDAI ION It PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL 3EPARATOR(ENCLOSED SYSTEM) <br /> �O LEACH LINES LEACHING CHAMBERS �(\P, Y�TI;1'C #OF LINES LENGTH OF LINES � ft <br /> DISTANCE TO NEAREST WFI 1 (, I"t fl FOUNDATION )(✓T T ft <br /> �(_ ft PROPERTY LINE _ <br /> ❑ FILTER BED WIDTH ft LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL <br /> SUMPS WIDTH _ ft FOUNDATION ft PROPERTY LINE f( [3� <br /> ❑ ft LENGTH ft DFPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE-_fl <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ti <br /> DISTANCE TO NEAREST WELL •`7 <br /> / ft FOUNDATION ft PROPERTY LINE ft <br /> '2I SEEPAGE PITS NUMBER \ WIDTH �L�» F ft DEPTH 21 ft <br /> DISTANCE TO NEAREST WELL 1'lL-)t ft FOUNDATION I D ft PROPERTY UNE J.r 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 /> I { REQUIREDFOO 7 <br /> SIGNED lL�(,L TITLE I DATE <br /> I <br /> i <br /> c MENT <br /> - - 252020 <br /> N�'1EN°UNT y <br /> EP4 L <br /> q RT(46NT <br /> PAP—CAtr uCc nM,l _ <br /> Application Accepted 6 Y J � 5 i <br /> !i- AreaEmployee ID# <br /> Final Inspection By Date <br /> d✓ r SPECIAL PERMIT-Approved by <br /> Character of Sol[to Depth of 3 IUSurrlp Soil Character: <br /> r COMMENTS {v�' +y$Fern t ✓ 7 <br /> tl�:vl Sto"vt C�r�r 47o,- Vr 1'' f rF/ .aJi r7j /ct�ll�i1/pr's e�1vc'/SrPJr tCn�C /MG.t 1.�. �� Gati'�►L''� <br /> I / L/ <br /> �1 K at l C " C� Fy'' � .1l 16 <br /> �' Ill <br /> PE SC Received Checkl#/ Amount Permit/ <br /> Code INFO ash Remitted Date Service Re uest# Invoice# Permit IDN <br /> 1'' /Gid <br /> !X <br /> 42-U1 <br /> 4JI41I8 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> ll�t� l��z� ll�fs51 j <br />