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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 m EXPIRES/1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS O L- �d I ( ITY/ZIP V /r <br /> CROSS STREET / F I✓C�<'(eG7 APN !/ I f DCS I PARCEL SIZE <br /> OWNER NAME ( 'ar��� �J7 .JUf /F,/y411 PZ PHONE <br /> OWNER ADDRESS `/ /f CITY/STATE/ZIP 7 �j <br /> CONTRACTOR fl , jb r4� VQ[` � e(�F1t PHONE �-/ —JCP���/��-((��S 0, �7 <br /> CONTRACTOR ADDRESS 3 74 z e-A-,o A GG 1� CITY/STATE/ZIP Sfs C t/7 'f C <br /> LICENSE 11 <br /> �`-42 ❑OC-36 OTHER NUMBER lJ�S7O7.�EXPIRAT10N DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# -Z 1 c 1 LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION J ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM 11 DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG 61 sle'ick CAPACITY z4Z067 gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ^0 / / Y ft <br /> 3co ft FOUNDATION � ft PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ,❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> , I LEACH LINES -: LEACHING CHAMBERS ^� #OF LINES LENGTH OF LINES :55 � ft <br /> ( \ DISTANCE TO NEAREST WELL 7Ci0 ft FOUNDATION ��J , ft PROPERTY LINE F7 f 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 TON AREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> l SEEPAGE PITS NUMBER 3 WIDTH 160 ft DEPTH 1 26 ft <br /> DISTANCE TO NEAREST WELL 366 ft FOUNDATION �O ft PROPERTY LINE 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 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE C��P/�cI(/«— DATE <br /> i <br /> lY <br /> HIE RMNT <br /> DEPARTMENT,USE ONLY ( QQ <br /> Application Accepted By Date n� f� Area I /7 J Employee ID# <br /> Final Inspection By Dater/ C SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth t: Pit/Sump Soil Character: <br /> COMMENTS5 s , our Gl Glued rrNrrL S �a�' a 144 <br /> PE SC ReceivedCheck#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Cas Remitted Service Re est# <br /> iq 2,L� -15­tl L . <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />