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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 CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS ' <br />'7_1 ( <br />C <br />CITY/ZIP 7Tr&ri'V ` /_ _�s Z -"w <br />CROSS STREET <br />D (4 ,{/ +' <br />' Efi! <br />APN (,� l L� PARCEL SIZE <br />OWNER NAME <br />�! k-, S- -S /I q1' <br />R <br />JL/ 17-n�i <br />PHONE 7()l - / l /IY4 / <br />OWNER ADDRESS y/>/moi CITY/STATE/ZIP <br />CONTRACTOR e//e,4 z/ V:///1w PHONE 2 C- / C 24-f - �d 7 <br />u <br />CONTRACTOR ADDRESS .���Ccr� �`/" �.` CITY/STATE/ZIP <br />LICENSE 'J }G-42 '._'.0-36 OTHER NUMBER T � G EXPIRATION DATE <br />El: -C-36 <br />I P, _ I <br />WATER TABLE DEPTH: <br />u <br />ft GEOGRAPHICAL INFORMATION: COor In tes X Y <br />Amount Date Permit/ <br />Remitted , Service Request # <br />PERC TEST # <br />BUILDING PERMIT # <br />AND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION <br />R <br />AIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL <br />SERVE: RESIDENCE <br />E. <br />COMMERCIAL L OTHER <br />A <br />NUMBER OF LIVING <br />UNITS: <br />OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />Xu, <br />SEPTIC TANK <br />/NUMBER <br />TYPE/MFG Lewes/c <br />zCAPACITY <br />Z2dCJ yal #OFCOMPARTMENTS <br />GREASE TRAP <br />TYPE/MFG <br />CAPACITY gal # OF COMPARTMENTS <br />[we] <br />DISTANCE TO NEAREST: <br />WELLf ft <br />FOUNDATION / -] ` ft PROPERTY LINE 'poo ` ft <br />❑ <br />LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />�1 <br />D0 <br />LEACH LINES <br />LEACHING CHAMBERS// <br /># of LINES_ LENGTH OF LINES �� ft <br />DISTANCE TO NEAREST <br />WELL 200 ` ft <br />FOUNDATION / ft PROPERTY LINE 2ft <br />❑ <br />FILTER BED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION ft PROPERTY LINE F34 <br />'A WAIII ft <br />Ll <br />MOUNDED <br />WIDTH <br />ft LENGTH <br />/� <br />ft DEPTH ip _CI11 ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION ft PROPERTY LINE � ft <br />q <br />LI <br />SUMPS SUMPS <br />WIDTH <br />ft LENGTH <br />(7 <br />ft DEPTH n ft <br />DISTANCE TO NEAREST <br />WELL ft <br />7�r,�,, <br />FOUNDATION ft PROPERT`SO 011 ft <br />Ll <br />DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft DEPTH �gQwN ft <br />DISTANCE TO NEAREST <br />WELL ft <br />Tir <br />FOUNDATION ft PROPER TH p�-�NTgI ft <br />L3 <br />SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH �RrA4ENT ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION `i Y ft PROPERTY LINE ��Cy 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 />- - - - ]7C■ �.■tel •..1.- <br />- - /4 L-/ <br />Che <br />Amount Date Permit/ <br />Remitted , Service Request # <br />Invoice# PermitID# <br />1■■■■►'.1�1iil�ilirir■■■■■r■r!■i■■■!!i!■!►�llill�I�II�!!■■■! <br />1 D <br />1■■■■■■■■■■■■■f <br />1!■■■■■■■■!!■!■L'!V■����i!!■■■■■11■■■■leffiRIMtla■■■ <br />�:;t■■■■MEN <br />■■■■■■■■■ENNINNi■■■ <br />I <br />a <br />A- <br />[we] <br />PE <br />Code <br />SC Received <br />INFO B <br />Che <br />Amount Date Permit/ <br />Remitted , Service Request # <br />Invoice# PermitID# <br />1 D <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />T <br />