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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE PERMIT <br /> S V I CALL 209�9n53-7697 FOR INSPEOS EXPIRESp1!YEAR FR <br /> OM DATE ISSUED <br /> JOB ADDRESS Al+-Ac^-rT CrrY21P A-C PD <br /> CROSS STREET GP-&P -H GIN-Tr- <br /> a <br /> APN 00-1- JI 0 3 I PARCEL SIZE k3 At • g <br /> r 7 e <br /> OWNER NAME �`&991yI IJ ?Hj`Lk P -PHONE ry�37-'1 -aC�1,4 <br /> OWNER ADDRESS E T ---CITY/STATE/ZIP i'Cc-A 1 V�-P0 C,7 _t 2'Zy <br /> CONTRACTOR L-1 V C C+ � G� NV I(-DIVnL_ PHONE 3 Loci -O 3-7I - <br /> CONTRACTOR ADDRESS 40,1 W d� T CITY/STATE/ZIP L-07 l C- r�,�U <br /> LICENSE ❑IC-42 ❑OC36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION 0 ENGINEER DESIGNED/ALTERNATIVE <br /> Cl REPLACEMENT 0 OUT-OF-SERVICE SEPTIC SYSTEM 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEMIFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELLft FOUNDATION ft PROPERTY LINE 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 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <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 N EAREST 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 ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION Tft PROPERTYLINE 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 /> MINI MR NEN T/ REQUIRED FOR INSPECTIONS-PLEASE ALL 2 7 <br /> SIGNED TITLE )D�O� �R DATE <br /> M I T ' <br /> C- <br /> V <br /> 00 <br /> \�-s�f m/8 <br /> cicl <br /> Nr <br /> F• <br /> DEPARTMENT U E ONLY 0 tJ 2�?0 <br /> Application Accepted By�^ �� Date 7/ o./� Area Employee ID#4- 5,1nuVL- <br /> AQ //V COUN <br /> Final Inspection By Date 0 SPECIAL PERMIT-Approved by ' RRT'� Ty <br /> Character of Soil to Depth of 3 Ft: PiUSump Soil Character: MENTI <br /> COMMENTS <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO BV Remitted Re uest# <br /> �►a�� s�3 15,z yjIbI22 <br /> • 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />