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16 <br /> 't 1� <br /> 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 /3 CALL <br /> Q2/09 9$3-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS _10 3 91 NH IA- / 7 CITYIZIP G 2 �' <br /> � Q. I APIN � JCROSS STREET dPARCEL SIZE <br /> OWNERNAME__�r_��4 . 129-s PC�H-OCJ`NjTE(aV�o V�;zA j),j — J(T zd <br /> OWNER ADDRESS gT2 —OC 64yotic -E CITYISTATE/ZIP <br /> CONTRACTOR Doner <br /> C <br /> PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑i.0-42 Eli.0-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> G PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION ;�1 ENGINEER DESIGNED ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM xl DESTRUCTION±90 <br /> INSTALLATION WILL SERVE: E RESIDENCE C COMMERCIAL E OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal *OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> PA- <br /> CI LEACH LINES F1 LEACHING CHAMBERS #OF LINES LENGTH OF LINESY <br /> c—1 <br /> fr <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE �r <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE!�-- <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH JUAn <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINA rtOArva.Y COlIA�-Sl <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH b ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE NAt <br /> i <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH It DEPTH it <br /> DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE It <br /> (3 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPA ED 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 /> M11JMUd48 IfOUR "0"CE REQUIRED FOR -7 <br /> 69 <br /> SIGNE TITLE tJ L✓YI rL DATE D <br /> DE d ENT ,1J,-f,Y <br /> Application Accepted By <br /> ,� �;;'", ; Date O Area nI I'1 r Employee IDIt. <br /> Final Inspection By Data\� Z `l5�'LhI E SPECIAL PERMIT-Approved by <br /> a <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS-,NO �Albti)t5 /r':I:1c61110.Itc 071 Jro)"• SF'p)14 �C-InC rEIYI�r,YI� rim gL�( C�t°ia�ole��r�% <br /> PE SC Received Check#/ Amount PermiU _ <br /> Code INFO IiCash Remitted Date Service Request# invoice# Permit ID# <br /> fid) o7s $�5 (Pj- <br /> 42.01 J�J ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 l.-"' "1 �I l✓���+G.L7J <br />