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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 V G CITY/ZIP / S <br /> CROSS STREET ////JX�/J� � APN , IJF�U�� PARCEL SIZE r <br /> OWNER NAME R P/1 PRR J,..,PHONE.1/�-�7 7 <br /> OWNER ADDRESS <br /> - 9ox C' CITY/STATEMP SGS�+�ki-J%' G S 0 S <br /> CONTRACTOR �yG��,,,, PHONE /- S-6. z 7 <br /> CONTRACTOR ADDRESS //SO ,%4' 1 A'15-- I� CITY/STATFIZIP <br /> LICENSE ❑K42 2 CC-36 OTHER NUMBER �E%PIRATION DATE <br /> WATER TABLE DEPTH: v C It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> LI PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIWADDTnON ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> tldSEPTIC TANK TYPEIMFG , �V CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION it PROPERTY LINE ft <br /> O LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> x- ----- --- - --- ---- — --- f\ ------ <br /> LEACH LINES - LEACHING CHAMBERS #OF LINES 4'2 _ LENGTH OF LINES y ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ZU' It PROPERTY LINE / r It <br /> ❑ FILTER BED WIDTH It 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 It FOUNDATION ft PROPERTY LINE ft <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 It <br /> DISTANCE TO NEAREST WELL /it FOUNDATION It PROPERTY LINE It <br /> SEEPAGE PRS NUMBER WIDTH 7 ft DEPTH S I It <br /> WELL ft <br /> DISTANCE TO NEAREST WEft FOUNDATION ft PROPERTY LINE <br /> I HEREBY CERTIFY THAT]HAVE PREPARED THIS APPUCATION 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 /> R / Tl - LE 2 -7 7 <br /> SIGNED TITLE DATE IS"zO <br /> IDA VN7" <br /> ED <br /> 20?0 <br /> U <br /> — <br /> TIAL Ty""CNT <br /> DEP RT EENT E ONLY <br /> Application Accepted By _ L Date S O Area / �C Employee ID# _ <br /> Final Inspection By� r �— Date11�j u W ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Plt/Sump Soil Character: <br /> COMMENTS f,-V i S („WI fel P b<,•C kS per, I <br /> RID 3)- <br /> Of O <br /> PE hSC Received hoc #/ Amount Date Permit/ Invoice# Permit ID# <br /> Code B asRemitted Service R uest#LO IS 2a S <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />