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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 <br />NON-REFUNDABLE PERMIT ( t' I ) CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />poocK <br />CROSS STREET E <br />OWNER NAME <br />OWNER ADDRESS <br /> <br />CITY/STATE/ZIP <br />JOB ADDRESS CITY/ZIP S11- 0C--1001\ <br />AP N I 1-1-6 6 Lj- PARCEL SIZE -Z <br />PHONE <br />CONTRACTOR illt) IV-ALS 6efe-1(1 1 e Q. PHONE Li SL —3--- <br />CONTRACTOR ADDRESS P( PO X C rrY/S TATE/ZiP /44. 336 <br />LICENSE DC-42 El LC -36 OTHER <br /> <br />NUMBER LP 6 EXPIRATION DATE ;40 a a_ <br />PA y <br />IVIEN <br />JUN <br />11S-AljV°1,1y4 0C? NUIN COU trN 114PAI. IVY <br />D P/4;7 tAL• <br />trW 202/ <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />WATER TABLE DEPTH: <br />PERC TEST # <br />ft GEOGRAPHICAL INFORMATION: COOrdirteS X <br />BUILDING PERMIT #_..)P - 2(0115 LAND USE APPLICATION # <br />TYPE OF WORK: <br />Li <br />NEW INSTALLATION <br />REPLACEMENT <br />LI REPAIR/ADDITION <br />Li OUT-OF-SERVICE SEPTIC SYSTEM <br />Ll ENGINEER DESIGNED /ALTERNATIVE <br />LI DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: RESIDENCE T COMMERCIAL <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />E OTHER <br />NUMBER OF EMPLOYEES: <br />SEPTIC TANK <br />0 GREASE TRAP <br />0 LIFT STATION <br />TYPE/MFG CAPACITY I. D C> gal # OF COMPARTMENTS a. <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION (00 I ft PROPERTY LINE S-t ft <br />SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />1-10- %A LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 5 ' ft <br />0 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />4;1/r'SEEPAGE PITS <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />NUMBER WIDTH <br />ti 34 ft DEPTH ft <br />DISTANCE TO NEAREST WELL ES'e, ft FOUNDATION ft PROPERTY LINE s' ft <br />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 HOUR D1/...ANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7(97 <br />SIGNED TITLE 6-D r\d-41-e----.ç DATE 0 6/ 01 <br />(Y Employee ID# <br />6/1//2 07J\ E SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS <br />Application Accepted By <br />Final Inspection By <br />I • EPARTMENT USE ONLY <br />4 I _dm. Date i-.7/2/ Area <br />cp 42,s1.10741W vier Date <br />A (7 :SS311UUV 311S PE <br />Code <br />SC <br />INFO <br />Received <br />_By <br />Check# Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />47-1 1 1 I /y2 - de <br /> <br />S 4,4-- co-Lit \lq Doi3 ge <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18