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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 E <br /> XPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1 �! i6 s C-r m P t( ►Q V CITY/ZIP SC.`>'[7 n I C,Ar LA <br /> CROSS STREET MV1-e G( y APN �� —3�— OPARCEL SIZE <br /> G <br /> A <br /> OWNER NAME PHONE m <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTORCr <br /> S G(<kn. i PHONE <br /> CONTRACTOR ADDRESS d") CITY/STATE/ZIP C✓Io��C�31�A S3 0 <br /> LICENSE ❑ C-42 1111C-36 OTHER I� NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: 0 v q� , ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# 003 31—ss LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION LI REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: %/�ESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: nI NUMBER OF BEDROOMS:.3 NUMBER OF EMPLOYEES: <br /> O'/SEPTIC TANK TYPE/MFG /'f/ L CAPACITY I gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL 166 L ft FOUNDATION Zp ft PROPERTY LINE -),S 4- ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> bl LEACH LINES LEACHING CHAMBERS #OF LINES <br /> ��11� LENGTH OF LINES ]_I ft <br /> DISTANCE TO NEAREST WELL 165+ ft FOUNDATION 101 ft PROPERTY LINE -20I ft <br /> ❑ FILTER BED WIDTH ft 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 u ft FOUNDATION ft PROPERTY LINE ft <br /> ❑' SEEPAGE PITS NUMBER J WIDTH 1� I t ft DEPTH �S ( ft <br /> DISTANCE TO NEAREST WELL �CZCJ'I ft FOUNDATION 2b I ft PROPERTY LINE bI 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 HOJJR ADVANCE NOTICE RE IRED FOR INSPECTIONS - PLEASE CALL 209)953-7697- <br /> SIGNED <br /> 7 97SIGNED TITLEDAT <br /> AA <br /> J <br /> ^q C <br /> 44 <br /> EPARTMENT SE NLY , <br /> Application Accepted By Date Area sp© / Employee ID# JU' ft ? <br /> a <br /> Final Inspection By Date 11 SPECIAL PIERMIT-Approved by <br /> Character of Soil <br /> �toDepth of 3 Ft: Pit/Sump Soil Character: LO I�� <br /> COMMENTS / l;r4 10 <br /> PE SC Received OheckW Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B P Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />