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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAIELTON AVENUE-STOCKTON CA 95205-12091683420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS .� 3C1TYIvZP <br /> 7CROSS STREET 50c /9 APN � �8 O PARCELSD� � y-1 <br /> c <br /> OWNER NAME E 12 /'}F(' (l L (�(^; -:(.. PHONE 10 <br /> I ( LL <br /> OWNER ADDRESS r7 lrl I h CITYISTATEMP <br /> CONTRACTOR �44lfI/ uy�I`/'�`�V�'J✓L���C� /� h PHONE ('34 9—.'5-627 <br /> CONTRACTOR ADDRESS 3 T Q /�"'� I��+'• �_F Pe CIT11STATEfZIP JACl/"^i C& <br /> LICENSE YC-42 C-36 OTHER NuMBETt ymowExnMnoN DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # —� BUILDING PERMR# J i <_ LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIAODHTIoN ENGINEER DESIGNED/ALTERNATIVE <br /> REPLAcsMENT OUT-OF-SERVICE SEPTI SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: �rRESHDENCE COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: _/ NUMBER OF BEDRbOMS: 3 NUMBER OF EMPLOYEES: <br /> 0 <br /> �S SEPTIC TANK TYPFJMFG eCHCw' / / L CAPACITY -4'Y gal #OFCOMPARTMENTS a <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL /5O / ft FOUNDATION ' ft PROPERTY LINE / ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP Cl PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> )tl LEACH LINES LEACHING CHAMBERS #OF LINES (3)l LENGTH OF LINES ✓S ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ;?42 ft PROPERTY UNE ft <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE It <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY UNE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLIt FOUNDATION ft PROPERTY UNE ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE C NEAREST WELL It FOUNDATION It PROPERTY UNE ft <br /> SEEPAGE PITS NulllER3 WIDTH �a sa ft DEPTH 07�8/ ft <br /> DISTANCE TO NEAREST WELL 80 ft FOUNDATION O ft PROPERTY LINE J Q / 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 /> MINIMUM48H 110 AQyA=NOTICE REQUIRED FOR INSPECTIONS-P-LEASE CALL(20919&3-7697 <br /> SIGNED TITLE DATE T�.?0—�C <br /> I <br /> F�A MFNr <br /> ��VFO <br /> ±T±##t1�­ o Zozp <br /> Application Accepted D P RDateE U" Area / ' EIT, .elD# FIy�IRop ��o�N� <br /> Final Inspection By 1A�L�� Date Zl: SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 R: PittSump Soil Character: I+IT <br /> COMMENTS NP,J S F h i: "l\' �11+ A0 01 L-Vt�— <br /> PE Sc Received Amount Date Pem1w Invoke# Permit ID# <br /> Code INFO Cash Remitted Service R uest# <br /> ti <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />