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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 EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZIP <br /> .j <br /> CROSS STREET y P�� TrVAPN l J 7V PARCEL SIZE p <br /> v <br /> z <br /> OWNER NAME PHONE y <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR � -ryI / L w1f ( PHONE _201 If —�-?&� — L/ �' <br /> CONTRACTOR ADDRESS �3 7�fl C�W 'Z/ ///' CITY/STATE/ZIP yl <br /> / <br /> 7UG C�j- /J lqz <br /> LICENSE 0*42 Ell-IC-36 OTHER NUMBER61�V611/5_EXPIRATION DATE <br /> WATER TABLE DEPTH: 10 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: LI NEW INSTALLATION R AIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> CI REPLACEMENT J OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG >n'�" CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP L3PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LJ \j <br /> LEACH LINES J( LEACHING CHAMBERS n / #OF LINES LENGTH OF LINES 4�1 ft <br /> DISTANCE TO NEAREST WELL /"t!7//'C ft FOUNDATION ft PROPERTY LINE 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 ft FO UN A(T�/QN ft PROPERTY LINE ft <br /> E3 SEEPAGE PITS NUMBER r4 I WIDTH �!l ft DEPTH ft <br /> DISTANCE TO�TEAREST WELL&bA_4 ft FOUNDATION ft PROPERTY LINE 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> 17 <br /> SIGNED TITLE DATEIt <br /> f <br /> f Q / <br /> y M <br /> IbEPARTMENToUSfYONLY ��/�/� Ta�)E <br /> Application Accepte y&*y <br /> Date Area �t'Ya, I Employee ID# <br /> Final Inspection By Date 2 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to epth of 3 F Pit/Sump Soil Character: <br /> : <br /> COMMENTS r �Y/I� pq- <br /> _ i� <br /> L O Nri 4 Y <br /> O % <br /> P Y SC Received ec Amountermit/ <br /> Code INFO B ash Remitted Dat Service Request# Invoice# Permit ID# <br /> 0 d O -- `ll <br /> 42-01 SITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 Oc� i'C woo , _lC.� -& W/ " ' <br />