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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95206.(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 9S3-7697 FOR INSPECT70NS/ EXPIRE <br /> �S <br /> JI YEAR FROM DATE ISSUED <br /> JOS ADDRESS CiTY/ZiP .S1l'�C�D `7 S�21� J <br /> CROSS STREET JLC/T .<r�1P`/D�J APN `� rte' j PARCEL SIZE ". <br /> OWNER NAME 11`i 2A M- r�J`j��,/I,rf�G ) PHONE <br /> OWNER ADDRESS '�w u""" CITYISTATE21P <br /> CONTRACTOR __--/t-)��Jd4r �J'Qi .W� G f...r/,- PHONE <br /> CONTRACTOR ADDREss T .6:' I.,f�r/ � CITY/STATE/ZIP <br /> LICENSE 11:7C42 Or C46 OTHER_ NUMBER EXPIRATION DATE�l2 -7/ <br /> WATER <br /> WATER TABLE DEPTH: -�L.' 1 ( ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> C PERC TEST # F BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: C NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM .. DESTRUCTION <br /> INSTALLATION WILL SERVE: 'Q-RESIDENCE D COMMERCIAL OTHER <br /> NUMBER OF LmNG UNITS: j NUMBER OF BEDROOMS: 2 NUMBER OF EMPLOYEES: <br /> O SEPTIC TANK TYPE/MFG L• 'T ' �y CAPACITY gal #OF COMPARTMENTS <br /> - <br /> • GREASE TRAP TYPE/MFG / CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL it FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS *OF LINES LENGTH OF LINES r It <br /> DISTANCE TO NEAREST WELL lDa'A ft FOUNDATION J/7 It PROPERTY UNE O R <br /> ❑ FILTER BED MOTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIoTH ft LENGTH It DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE h <br /> SUMPS WIDTH /V L, R LENGTH Z--f . It DEPTH 4e --) it <br /> LI, <br /> DISTANCE TO NEAREST WE ,ad d �' ft FOUNDATION /,g 'LZ It PROPERTY LINE , -�- ft <br /> ❑ DISPOSAL PONDS MOTH ft LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS Numum WIDTH It DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE h <br /> !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. �y <br /> AM01 412VAiXgg NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 1209)953-769 <br /> SIGNED TITLE G rO DATE <br /> I � <br /> ~ Area �" �r t Employee ID# (A,(""Y <br /> App8catlon Accepted Data <br /> Final InspeeUon By Date 7,� .c�D 0 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS-.. tI&Qg*tZjj&i&9b�2 <br /> PE SC Received C ac Amount Dam Permit/ Invoice 0 Permit IO# <br /> Code INFO B Remitted Service Re oast <br /> 16 0042.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />