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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 <br /> <br />EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS <br /> JAAA .edt 45 CITY/ZIP 51-0(..it*/ A -14 <br />CROSS STREET <br /> <br />Q K tAl arad- AP N <br /> <br />PARCEL SIZE <br />OWNER NAME <br />PHONE <br />OWNER ADDRESS 6,91,5" VC-.1 41 14p, 10 0 CITY/STATE/ZIP s+oc,44,21,--4 cis-)46- <br />CONTRACTOR , I K..(2.3 c<a< Slect PHONE <br />CONTRACTOR ADDRESS <br /> 6,4.1,4 gb <br />CITY/STATE/ZIP <br /> 4 &4 AI, `3,? <br />LICENSE LJ C-42 [IL IC-36 OTHER <br /> <br />NUMBER (.570 ss-si EXPIRATION DATE _O-W-0 <br />WATER TABLE DEPTH: Id 3 ft GEOGRAPHICAL INFORMATION: Coordinates X <br />PERC TEST # <br /> <br />BUILDING PERMIT # 29)0 32-4g LAND USE APPLICATION # <br />TYPE OF WORK: V NEW INSTALLATION <br />REPAIR/ADDITION I I ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT <br />OUT-OF-SERVICE SEPTIC SYSTEM I I DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: iv-1TE SIDENCE 111 COMMERCIAL <br /> <br />NUMBER OF LIVING UNITS: f NUMBER OF BEDROOMS: - 3 <br />E OTHER <br />NUMBER OF EMPLOYEES: <br />04-EPTIC TANK TYPE/MFG <br /> <br />CAPACITY ES gal # OF COMPARTMENTS a <br />GREASE TRAP TYPE/MFG <br />CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL I <br />ft FOUNDATION 10 I ft PROPERTY LINE ga <br /> <br />ft <br />LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />e ? 'rEACH LINES C LEACHING CHAMBERS # OF LINES LENGTH OF LINES SS- i ft <br />DISTANCE TO NEAREST WELL 00 I VI- ft FOUNDATION o ft PROPERTY LINE 55 r ft <br />0 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />CI MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUM PS 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 3 WIDTH 4(,) il ft DEPTH t9tj 1 ft <br />DISTANCE TO NEAREST WELL i 501 ft FOUNDATION —)5- % ft PROPERTY LINE <br /> <br />;101 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 HOU ADVANCE NOTICE RE UIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> <br />TITLE C-0,YWII DATE I( 5-frJo - SIGNED :SS311CICIV 311S NO <br />/1FAAQUify IRavitfpC0 <br />"' DE84411 <br />MEN <br />SAN o20 <br />DEPARTMENT U/SE ONLY <br />Application Accepted By /2— Date j S Employee ID# 1)4 <br />Final Inspection By A_ Date 1 20 202_1 C SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS Met,' s FR. Srtond v,,7 )71 , rip ,- /I- tAfrIlg sci64cks icyfoc- <br />riopyi record. feikiOR ro.-ed 410 vefirk coviadions konn ivubi le hoikt, <br />4i d A A.1, A 5 ilia) 7P <br />PE <br />Code <br />SC <br />INFO <br />Received eck# Amount <br />Remitted <br />J <br />Date Permit/ <br />Service Request # Invoice # Permit ID# <br />Lial I I CI WM/BY 1 (Q (1 4 '71 09/0 5PYIALI'Ll <br />42-01 12,C42:Wee. S‘.1\00..) <br />4/14/18 <br />lartQji0 PA5 • L.k 243 - <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />Area Li <br />0 ii