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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 5023 E Ashley Lane CITY/7JP Stockton 95212 <br /> CROSS STREET RUR APN 086.070-22 PARCEL SIZE 2 91 Acres i <br /> OWNER NAME BIII&Katherine Williams <br /> PHONE 209-649-9894 <br /> OWNER ADDRESS 8027 W Howard Road CITYISTATE/ZIP Stockton.CA 95206 ! <br /> CONTRACTOR Affordable Fence&General Construction PHONE 209-948-4415 <br /> CONTRACTOR ADDRESS 2712 E Fremont Street CITY/STATE/ZIP Stockton.CA 95205 <br /> LICENSE C-42 _ C-36 OTHER B C13 NUMBER 605338 EXPIRATION DATE 10131/2020 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUIL DING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: k NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: X RESIDENCE COMMERCIAL P&.- g P OTHER <br /> NUMBER OF LIVING UNITS: 2 CONUMBER OF BEDROOMS:S" 04C1scrMMJ%1 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG +L Ct CAPACITY 00 <br /> gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> .� LEACH LINES h LEACHING CHAMBERS 2V <br /> 0 fUQ #OF LINES _ LENGTH OF LINES 90 ft <br /> DISTANCE TO NEAREST WELLL_It FOUNDATION i Q It PROPERTY LINE '70" ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It 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 It LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO/NNE.AREST WELL ft FOUNDATION ft PROPERTY <br /> `LLI E R <br /> SEEPAGE PITS NUMBER 1WIDT�r V1awk'�r ft DEPTH cA") ft <br /> DISTANCE TO NEAREST WELL it—I O ft FOUNDATION 5n� ft PROPERTY LINE <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 /> ADVE NqTJ12E REQUIRED FOR INSPECTIQN�-PLEASE CALL(209)953-7697 <br /> SIGNED O IN r e-fes DATE <br /> F yMFN <br /> R 4 ?020 <br /> A o°N�N Dov <br /> FPq RT�ENTY <br /> DEPARTMENT S ONLY `I // <br /> Application Accepted B `/�v Date Z�L D Area ry qq Employee ID# 1� <br /> Final Inspection By Date SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMEN,N'T,S F K 1"tar - L Z6,L-, 0 <br /> PE Sc*Received Check#/ Amount Date Permit! Invoice# Permit ID# <br /> Code INFOCas Remitted Servic R u st# <br /> -IAIT- TL <br /> 42-ot ( � /D��`/ ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118-01 <br />