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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT % <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 9620$ - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS -Z U CITY/ZIP <br />l � j _/ l <br />CROSS STREET L / IN n( / j /� I Ul -� PARCEL SIZE �� v <br />OWNER NAME Gt ✓1 CJsI' J � /��� I �.PH/OJNE Z� 02 - N 7 -� 861 <br />OWNER ADDRESS 1,77a 7 'V Ae ��L%F-Gl_ CITY/STATE/ZIP WG:I V^ <br />c L <br />CONTRACTOR 5 e-& I e- 5e ro (c ec,� ` & fzotcp PHONE rG% 16 — ZD3-i V L S� <br />CONTRACTOR ADDRESS PD Li �C J OC/ L (� CITY/STATE/ZIP kh I 0rld -.� G^A 9J 6�f <br />LICENSE C-42 C-36 OTHER NUMBER Ob V1OJ, (PIRATION DATE ZJ ''-� I " r•-�J z:Z <br />�j0 -(5' 0 <br />WATER TABLE DEPTH: R � ft GEOGRAPHICAL INFORMATION: Coordinates X V <br />F' PERC TEST # <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION REPAIR/ADDITION <br />ENGINEER DESIGNED/ LTERNATIVE <br />ft LENGTH <br />,I <br />X REPLACEMENT 1f '( OUT -OF -SERVICE SEPTIC SYSTEM <br />r <br />DESTRUCTION L V <br />INSTALLATION WILL SERVE: ?( RESIDENCE i COMMERCIAL <br />I OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES:? <br />114 SEPTIC TANK <br />/ <br />- TYPE/MFG E5 L. CAPACITY <br />9a1 # OF COMPARTMENTS C� <br />❑ GREASE TRAP <br />TYPE/MFG CAPACITY <br />gal # OF COMPARTMENTS <br />ft DEPTH ft <br />DISTANCE TO NEAREST: WELL ft FOUNDATION / OO <br />ft PROPERTY LINE /(J O 4- ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES LEACHING CHAMBERS # OF LINES <br />Z LENGTH OF LINES ft <br />DISTANCE TO NEAREST <br />WELL 4- ft FOUNDATION /0 ft PROPERTY LINE /00 4- ft <br />❑ FILTER BED WIDTH <br />ft LENGTH <br />ft DEPTH It <br />DISTANCE TD NEAREST <br />WELL ft FOUNDATION <br />ft PROPERTY LINE It <br />❑ MOUNDED WIDTH <br />ft LENGTH <br />ft DEPTH It <br />DISTANCE TO NEAREST <br />WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS WIDTH <br />It LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />SEEPAGE PITS NUMBER 2 <br />WIDTH 3 <br />It DEPTH Z > It <br />DISTANCE TO NEAREST <br />WELL / w 4- ft FOUNDATION 6 <br />It PROPERTY LINE /©U {. 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 HOUP-Al2YANCE <br />NOTICE REQUIRED FOR INSPECTIONS <br />- PLEASE CALL (2 09) 953-7697 <br />SIGNED <br />TITLE I` IN <br />L- DATE !( — Zg — Z S / <br />-i <br />m <br />0 <br />m <br />// / DEPARTMENT US ONLY <br />Application Accepted By L L_ Date S Area Employee ID#F k <br />Final Inspection By V"'I' ' kc _, (,'� 2 r � Date S 13 li SP CIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS E+ k! S,Iryr, rr F'C- re A,i 1 r;i //� i1 � •-, ,^, S -(� ,) , <br />(t�sfc�Fr j, c) <br />0"Y14 <br />PE <br />Code <br />SC Received Check#/ <br />INFO ash <br />Amount <br />Remitted <br />pate Permit/esInvoice # Permit ID# <br />Service Re ut # <br />42-07 <br />4/14/18 /- ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />