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I z <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 <br /> CALL 209 953-7697 FOR INSPECTIONS /� EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 7_1 _3q ��V&e CITY/ZIP HeiQK4�� ��eZ-O Z' <br /> CROSS STREET <br /> 54-*7 f p ,K APN Q0T0?8019 PARCEL SIZE 'L _ p <br /> a <br /> OWNER NAME JEC-4ZA P—T B X) PHONE <br /> OWNER ADDRESS �'� 3•'-T_ CITY/STATE/ZIP Ad 4/1 X f E?10 ��T O <br /> CONTRACTOR �7 GJiNGC9 Gc T�c <:? 0I / G.S PHONE g� D �-' '2 S <br /> / <br /> CONTRACTOR ADDRESS �� 1��X v� �0, `� /',{ —CITY/STATE/ZIP <br /> LICENSE ❑❑C-42 ❑❑C-36 OTHER It NUMBER10170!/7EXPIRATI,ONDATE -3 <br /> WATER TABLE DEPTH: I a ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION 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 /> Q SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> CP, GREASE TRAP TYPE/MFG j CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ! ft FOUNDATION ft PROPERTY LINE ft <br /> C:I LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL 199 d 4- ft FOUNDATION /OO 4- ft PROPERTY LINE .fib ft <br /> D FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> El 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 NUMBER WIDTH :91 S ft DEPTH Z-INft <br /> DISTANCE TO NEAREST WELL 1�' _ ft FOUNDATION 00 f ft PROPERTY LINE -IL 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 V DATE 1S -I ZOZO <br /> EV <br /> L <br /> HEAUNDEPARTMENT <br /> D.EPARTMENT SE ONLY <br /> Application Accepted _ DateI! 0do Area /��% <br /> g Employee ID#D_ <br /> Final Inspection By Date 25 O ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS FAhle J some ex, ern( br► . ex)s�ir S s4eyyl <br /> �� HtAIv -pa was -Eo- ' q 44 n4p,'W -f -F -f"- to 04, -r4- 19.1 h e <br /> PE Sc Received k#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Re uest# <br /> 40110 his 1( 2 TTI 35 sU )-� <br /> 442-01/14/18 a µ {�, �� ONSITE WAST WATER TRTMNT SYSTEM PERMIT <br />