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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 9 <br />2009553-7697 FOR INSPECTIONS EXP <br />IR <br />ES <br />1 YEAR FROM �DATE ISSUED <br />JOB ADDRESS (QOO E C uJy G�J S'"��1-� 9✓• CITY/ZIP <br />CROSS STREET w I LI A-10�`rm APN PARCEL SIZE /•Q <br />OWNER NAME D a"A-c._j ^" D .-S� LJD I �/A' 2 -f CPHONE t (9 opi 0 <br />OWNER ADDRESS , SACC. /� 'ENW <br />W1 CITY/STATE/ZIP G <br />CONTRACTOR VI. V -C c)My <br />C.tZ O <br />o olY j�*L�•q7��- PHONE 3(0 r <br />CONTRACTOR ADDRESS qO-i vu (f/fY�G SST. CITY/STATE/ZIP <br />LICENSE EFC-42 11 i:. C-36 OTHER LC'�' NUMBER 1 EXPIRATION DATE <br />WATER TABLE DEPTH: ff GEOGRAPHICAL INFORMATION: <br />`( PERCTEST #----L.] BUILDING PERMIT# <br />TYPE OF WORK: .., NEW INSTALLATION Ili <br />.. REPAIR/ADL <br />... REPLACEMENT .... OUT -OF -SERVICE SEPTIC SYSTEM <br />Coordinates X Y <br />LAND USE APPLICATION # <br />Cl DESTRUCTION <br />INSTALLATION WILL SERVE: - RESIDENCE L J COMMERCIAL L OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG <br />❑ GREASE TRAP TYPE/MFG <br />❑ LIFT STATION <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE OF PUMP <br />CAPACITY <br />CAPACITY <br />ff FOUNDATION _ <br />❑ PKG TX PLANT <br />TERNATIVE <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF Loves ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br />❑ FILTER BED WIDTH It 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 NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION 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 />MINIMU 8 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br />SIGNED TITLE 10La% • 6 2 . DATE <br />PT <br />Character of So <br />COMMENTS <br />OU/Vn, <br />MENT <br />PE <br />Code <br />SC <br />INFO <br />Received heck <br />B ash <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Re uest # <br />Invoice # <br />Permit ID# <br />■■■■■■■■■■■■■■I\\\\\\\\,■■�■■11111■■■■■■■■III,.III'lll',■■■■■■■IIIIIII'lll1 <br />■■■■■■■■■■■■■■��■■■■■►�■■■■■■ice■i�■■■■■■■■�:rr <br />■■■■■■■■■■■■■■■■1\■■■�■!■�i%:■■■■■■■■■■■■■■■■i <br />PON <br />■■■■■■■■■■■■■■■■■\1■u/.191/■■■■■■■■■�1■■■■ii�'+'1�171n11� <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■Wii��!{�. <br />77 <br />Character of So <br />COMMENTS <br />OU/Vn, <br />MENT <br />PE <br />Code <br />SC <br />INFO <br />Received heck <br />B ash <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Re uest # <br />Invoice # <br />Permit ID# <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />