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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 / EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS - CITY/ZIP S/411// <br /> j/,�I //� l <br /> CROSS STREET GGfJllnz �/f1 APN 0&S X03 c� PARCEL SIZE p <br /> OWNER NAME/�//LffCl��C!/ /��G��C�` PHONE <br /> OWNER ADDRESS PO J I ✓ CITY/STATE/ZIP S Ix p{1 c <br /> CONTRACTOR �i/7 /1Gj 7�!//JJ/�-f S '/J�: PHONE <br /> CONTRACTOR ADDRESS J/ �C� � i G I�.� CITY/STATE/ZIP <br /> LICENSE 114-42 00C-36 OTHER NUMBER EXPIRATION DATE 0:�/ <br /> / <br /> WATER TABLE DEPTH: /J ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# 9P-)70D-7(-,] LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: I9` RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: C) NUMBER OF EMPLOYEES: <br /> f$ SEPTIC TANK TYPE/MFG ` -4}6u�) CAPACITY �� gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL SSD,r ft FOUNDATION ft PROPERTY LINE /AD ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> �- LEACH LINES LEACHING CHAMBERS #of LINES �r LENGTH OF LINES 7� , ft <br /> DISTANCE TO NEAREST WELL l 14- ft FOUNDATION ICS ft PROPERTY LINE 4'O',Of- <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 PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER ' WIDTH y� r ft DEPTH S ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION PROPERTY LINE 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE tZ <br /> 3100 <br /> Cr <br /> a a <br /> c <br /> SZ <br /> DEPARTMENT USE ONLY <br /> Application Accepted Date o Area 11 Employee ID# DA <br /> Final Inspection By Date 2dL1A SPECIAL PERMIT-Approved by CR <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS pJP,vJ SFR- t r✓>' r✓a liw unl So;) "Ver ouPr It-c- , boe is d4 ,a7che---, bwtb <br /> b ieeer tblnn qj 'Vl h c h /e ih bF <br /> Io u?o din Art acct jesqte G4 �4 <br /> PE SC Received Amount Date Permit/ Invoice# Reif I <br /> Code INFO B Cash Remitted Service a nest# Ara <br /> L01 117 • Sgy 3� <br /> / sAro0 <br /> Lea c,l� li <br /> � S vie �� � M�IRS�IN <br /> *)OF-01 ONSITE WASTEV � <br /> 4/14/18 A m h, <br /> r <br />