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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 I EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS Lm.df 5 Kwd� <br />CROSS STREET2i <br />OWNER <br />OWNER NAME �7 <br />OWNER ADDR <br />CONTRACTOR <br />CONTRACTOR ADDRESS <br />LICENSE A,❑C-42 ❑OC -36 <br />)APN (O I I �y� PARCELSIZE <br />/3 /'J Pr�reY i jr?s I PHONE t%� �/'co <br />fE/ZIP ' 'J K <br />'M4 1"�`. CITY/STATE/ZIPor <br />oftooftommm,Df' <br />OTHE22 <br />R I NUMBER 705 EXPIRATION DATE,/Y 3 / <br />WATER TABLE DEPTH: V �V <br />❑ PERC TEST # [ <br />TYPE OF WORK: 3c NEW INSTALLATION <br />11REPLACEMENT <br />ft GEOGRAPHICAL INFORMATION: COOrdinateS X <br />BUILDING PERMIT # <br />LAND USE APPLICATION # <br />1/ <br />❑ <br />11 COMMERCIAL El <br />REPAIR/ADDITION <br />❑ <br />ENGINEER DESIGNED /ALTERNATIVE <br />❑ <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />❑ <br />DESTRUCTION <br />INSTALLATION WILL SERVE: .RESIDENCE <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />oftooftooft <br />OTHER <br />SEPTIC TANK � <br />�❑ GREASE TRAP <br />❑ LIFT STATION <br />'� LEACH LINES <br />❑ FILTER BED <br />❑ MOUNDED <br />❑ SUMPS <br />TYPE/MFG /1'/— <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL �l% 1 ft <br />SIZE TYPE OF PUMP ❑ <br />❑ LEACHING CHAMBERS <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WELL <br />ft LENGTH <br />CAPACITY /,� gal # OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />' ft <br />FOUNDATION c7 � ft PROPERTY LINE S <br />PKG TX PLANT L3 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br /># OF LINES � LENGTH OF LINES �S� ft <br />FOUNDATION //2 ft PROPERTY LINE �� ft <br />ft DEPTH ft <br />WELL ft FOUNDATION ft PROPERTY LINE ft <br />ft LENGTH <br />W <br />ELL <br />ft FOUNDATION <br />.ft LENGTH <br />WELL ft <br />FOUNDATION <br />ft <br />ft <br />DEPTH ft <br />ft PROPERTY LINE ft <br />DEPTH ft <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYINE ft <br />SEEPAGE PITS NUMBER G'./ WIDTH S' ft DEPTH �S ft <br />DISTANCE TO NEAREST WELL,L�� ft FOUNDATION /Z� �� oftooft 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 />VR <br />SIGN <br />//YJrGli1IVIYJ � rLC/YJG {.r/'1LL (LVJ/ JJJ�I VJ/ <br />■ X11■■■■■■■■■■■■■�■Ifiiil`�■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■�i■■■■■■■■■■■■■■■■■I[liiiiiiii�i�:■■■■■■■■i■■■tri <br />■■1■■■■■■■■■■■■■■■■■lL■.......i!■ ■■■■■4�!i!! WO <br />PAP <br />soft <br />Aso 4 <br />COMMENTS <br /><FQ. rt <br />Perc t��f 5R oo$a61 ��_ ol�c,b� 4,t, %) pe✓I�� t Pe <br />r <br />PE Sc Received hec Amount Date Permit/ Invoice # Permit ID# <br />Code INFO <br />c <br />B ash Remitted Servie Request # <br />42-01 ONSITE WASTEWATER TRTMNT SY° <br />4/14/18 <br />VR <br />SIGN <br />//YJrGli1IVIYJ � rLC/YJG {.r/'1LL (LVJ/ JJJ�I VJ/ <br />■ X11■■■■■■■■■■■■■�■Ifiiil`�■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■�i■■■■■■■■■■■■■■■■■I[liiiiiiii�i�:■■■■■■■■i■■■tri <br />■■1■■■■■■■■■■■■■■■■■lL■.......i!■ ■■■■■4�!i!! WO <br />PAP <br />soft <br />Aso 4 <br />COMMENTS <br /><FQ. rt <br />Perc t��f 5R oo$a61 ��_ ol�c,b� 4,t, %) pe✓I�� t Pe <br />r <br />PE Sc Received hec Amount Date Permit/ Invoice # Permit ID# <br />Code INFO <br />c <br />B ash Remitted Servie Request # <br />42-01 ONSITE WASTEWATER TRTMNT SY° <br />4/14/18 <br />COMMENTS <br /><FQ. rt <br />Perc t��f 5R oo$a61 ��_ ol�c,b� 4,t, %) pe✓I�� t Pe <br />r <br />PE Sc Received hec Amount Date Permit/ Invoice # Permit ID# <br />Code INFO <br />c <br />B ash Remitted Servie Request # <br />42-01 ONSITE WASTEWATER TRTMNT SY° <br />4/14/18 <br />42-01 ONSITE WASTEWATER TRTMNT SY° <br />4/14/18 <br />