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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 f n CALL 209 953-7697 FOR INSPECTIONS �/ ��EXPIRES 1 C4 <br /> CROSS <br /> DATE ISSUED <br /> JOB ADDRESS <br /> V�-e a 1Q,i CITY/ZIP Sf 2c '' C/1 <br /> ( .� <br /> CROSS STREET �QI I YnGt r APN_D 02 <br /> / ' 1 3 c) —W IS PARCEL SIZE t <br /> C <br /> 0 <br /> OWNER NAME Ftaoc/S(J (mac,,r,,;a <br /> PHONE ter; <br /> OWNER ADDRESS Scir ,2 /�J C CITY/STATE/ZIP <br /> CONTRACTOR I Lee S C]C-a!�n�/i -�-t-i PHONE <br /> CONTRACTOR ADDRESS (.,�,]� CITY/STATE/ZIP G / <br /> LICENSE Ll C-42 111 iC-36 OTHER NUMBEREXPIRATION DATE-,)0,):j:) <br /> WATER TABLE DEPTH: `I V ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ri REPAIRIADDITION /ENGINEER DESIGNED/ALTERNATIVE <br /> f <br /> tREPLACEMENT JG,111- ? -11 N I� OUT-OF-SERVICE SEPTIC SYSTEM ( DESTRUCTION �Ct✓I IL <br /> INSTALLATION WILL SERVE: G-rcESIDENCE ❑ COMMERCIAL v�( r,Q l ❑ OTHER <br /> /NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: i r1 of,w�atl�:1 NUMBER OF EMPLOYEES: ^� <br /> lu SEPTIC TANK TYPE/MFG CAPACITY `� 3C) gal #OF COMPARTMENTS d� <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL I CRL7, ft FOUNDATION ft PROPERTY LINE Y i ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I <br /> LEACH LINES LEACHING CHAMBERS #OF LINES � LENGTH OF LINES d5]�— ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 3S' ft PROPERTY LINE (rJ/ ft <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 /> (d SEEPAGE PITS NUMBER �7 WIDTH �(� 4 ft DEPTH 4S/ ft <br /> DISTANCE TO NEAREST WELL I C lel' ft FOUNDATION –2 5_1 ft PROPERTY LINE t0 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 A VANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-71697 <br /> SIGNED TITLEDATE <br /> Oz <br /> �Q <br /> q 0 <br /> T O C <br /> q z <br /> N <br /> DEPARTMENT USE ONLY (� <br /> Application,Accepted �� Date n vt ,�owo Area a -/ Employee ID# fl <br /> Final Inspection By Date P W C SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS Moy)t4 :s)) sfl?M Cof fu?u/P PXD6015jon 0-r re';clel'ce TIP" <br /> . `e- Fa ,l u�-f <br /> e C04 OL <br /> PE SC Received eck Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Remitted Service Re uest# <br /> 10 s <br /> 14a s' I ?-o <br /> ( 0 a <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />