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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SIN JOAQU,N 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 Q C) `� - � -A/C /C CITY/ZIP � ��•J ) S 3 Z � Z' <br /> C M. <br /> i <br /> CROSS STREET Ffar t APN D ! / LI:7 PARCEL SIZE y <br /> ' C <br /> OWNER NAME ^e/� y ✓I��i �� �- PHONE z <br /> OWNER ADDRESS n Sit 61� CITY/STATE/ZIP <br /> CONTRACTOR / '&�CSe�j}Z S�F'r`L _Se PHONE <br /> CONTRACTOR ADDRESS Z (- , �� CITY/STATE/ZIP u� �Q- J/- ' <br /> LICENSE 11 C-42 DEC-36 OTHER NUMBER -l1 ll-3 EXPIRATION DATE <br /> WATER TABLE DEPTH: 190 0 �S� ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERG TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: iJ NEW INSTALLATION ( P REPAIR/ADDITION 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 /> ® SEPTIC TANK TYPE/MFG SJ 4'C L) /< CAPACITY f `--7-�—' V ) gal #OF COMPARTMENTS_ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ) ft FOUNDATION S ft PROPERTY LINE /11-S- ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES IJ- LEACHING CHAMBERS �� 3 #OF LINES LENGTH OF LINES L1 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ZG ft PROPERTY LINE S 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 /> ® SEEPAGE PITS NUMBJ <br /> ER Z WIDTH ft DEPTH 2 ft <br /> DISTANCE TO NEAREST WELL ��✓,� ft FOUNDATION -3o' ft PROPERTY LINE 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 ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED �— TITLE ( -iy 4,-,-.sk• DATE !U S,), F° 2 Q <br /> EN <br /> I VEO <br /> 2020 <br /> 7 Lk <br /> Nja <br /> E VI OIJNTy <br /> E 4 , <br /> TMT <br /> EN <br /> FR <br /> DEPARTMENT,USg ONLY <br /> Application AcceptedBy — Date Area yl� Employee ID# <br /> Final Inspection By (AQ l Date 2A ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft:`,� �� L�P� Pit/Sump Soil Character: �o <br /> COMMENTS fal�i lP �� s�/s�er� LXi�finu jot e>hc-j 5�)e'5jel7q. <br /> PE SC Received heck#/) Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Request# <br /> Iai41 iIs �Jo �D 3D2U Sna D5 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />