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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 2O9 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZIP o C <br /> CROSS STREET ,.)✓�U 7E �- APN OC_c,36� 9J > <br /> PARCEL SIZE rY�75, <br /> 1�` p <br /> OWNER NAME_)CCi'y _Z/5J1f� � <br /> PHONE Z Z- 5`2/ / <br /> OWNER ADDRESS ^S�7.1'I F_ CITY/STATE/ZIP <br /> /c. <br /> CONTRACTOR I44,& Z4//L PHONE <br /> CONTRACTOR ADDRESS /`� Z�-ITY/STATE/ZIP YVC/�/N•cJ <br /> LICENSE L-A 42 i C-36 OTHER NUMBER %> ?O V,MEXPIRATION 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 )it,REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: 2�1 RESIDENCE ,_! COMMERCIAL l_I OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: > NUMBER OF EMPLOYEES:_ <br /> ❑ SEPTIC TANK TYPE/MFG /J T/S�/tX' CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 01—ACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL I0o it FOUNDATION S�- It PROPERTY LINE It <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 It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> I� DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE It <br /> ►rr—SEEPAGE PITS NUMBER__ Z WIDTH It DEPTH 6 S ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION y/l ft PROPERTY LINE it <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 /> 48 HOUR ADVANCE NOTICE REQUIRED FORN E Tl EAE CALL 202)953-7697 <br /> SIGNED - -__ _ TITLE �,N1'%� DATE lI f� zv <br /> 17NVACR 1'7! J <br /> tic fIz- <br /> Nf�j yr <br /> VED <br /> 6 2020 <br /> ou <br /> co <br /> qAI'rdj <br /> aC <br /> TMFNT <br /> DEPARTMENT USE ONLY D� <br /> / i <br /> Application Accepted ��( �-�- Date I i �J' Area fl '-' Employee ID# <br /> Final Inspection By Date EY SPECIAL PERMIT-Approved by <br /> Character of Soil to vepth of 3 Ft: Pit/Sump Soil Character: <br /> COMMEN S J f , L A IS h"q( S 5ier" 0/1 t'A' ih SC) 70 <br /> P%-e- '' 2 due <br /> PE SC Received Ch mount Date PermiU Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Re uest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br /> i <br />