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I 4P <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE- STOCKTON CA 95205 • (209) 488-3420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 I T1FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS _ V%p a <br />tt Crrv/Trp m <br />CROSS STREET4sqr, <br />CaAPNWNER NAMEWNERADDRESS i"r�E <br />CONTRACTOR•,j�h�P3 enc _'7�c •�, 9 <br />73q,/ <br />PHONE <br />{�/�/��.L I/�J //�• yl- �ff� <br />CONTRACTOR ADDRESS max <br />iv(„(1 S•'�'. <br />_ <br />G CITY/STATEIZIP <br />LICENSE ❑C':C-42 ❑i=;C3OTHER__ NUMBER OTHENUMBER Si 15-7 EXPIRATION DATE / () <br />WATER TABLE DEPTH: <br />❑ PERC TEST # <br />F <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />❑ sePncrANlc <br />❑ GREASETRAP <br />❑ LIFT STATION <br />ft GEOGRAPHICAL INFORMATION: COOrdIDatBS X <br />BUILDING PERMIT# LAND USE APPLICATION <br />V <br />Imo' OUT -0F -SERVICE SEPTIC SYSTEM I_ DESTRUCTION _- w "•n^, •mac <br />RE3IDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />TYPE/MFG CAPACITY <br />TYPEIMFG gal #OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE <br />SIZE ft <br />TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES � <br />LEACHING CHAMBERS <br />I #oFLINEs � SS� ft <br />rf .t- LENGTH OF LINES <br />DISTANCE TONEAREST WELL `yQ I $ FOUNDATION ft PROPERTY LINE <br />❑ FILTER BED WIDTH ft <br />ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ MOUNDED WIDTH ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft <br />ft FOUNDATION ft PROPERTY LINE It <br />❑ SUMPS WIDTH ft LENGTH <br />It DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY UNE <br />❑ DISPOSAL PONDS WIDTH ft <br />ft LENGTH ft DEPTH R <br />_ / DISTANCE TO NEAREST WELL ft _FOUNDATION It PROPERTY LINE <br />ti/ SEEPAGE PITS NUMBER `i �j 5 ft <br />WIDTH t � tQ 7� R DEPTH L J) h <br />DISTANCE TO NEAREST WELL -y- ft FOUNDATION �Q ft PROPERTY LINE _ C; + <br />`®a R <br />f HEREBY CERTIFY THAT t 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 />Fr <br />O <br />Appltcatlon Accepted B ��a'�C--•�l ry � r �/ (' t1� <br />Date /i% i:,.a v Area -1 �% � Employee ID# !/ <br />Final Inspection By � Date eZ ❑ SPECIAL PERMIT -Approved by <br />Character of Soil tCo Depth of 3 Ft Pi Su Soil Character: <br />COMMENTS 1�1i�VyP U �)HN1 I,r /�1�;.�/Pl VJ >LiIIYI <c 1'c, 1-1t1� <br />42-Ot <br />4/14!18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />�y <br />