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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 <br /> /PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS v / AI �O� CITY/ZIP l��p G - <br /> CROSS STREET APN of-7' / drU - 12- PARCEL SIZE p ip <br /> OWNER NAME PHONE <br /> OWNER ADDRESS l / CITY/STATE/ZIP c� �^ �7 <br /> CONTRACTOR ?zdk- l' V��I �,/�JY/�//f��,1/..I/J PHONE 2C r ��`/7- / <br /> CONTRACTOR ADDRESS -CITY/STATE/ZIPC <br /> k`-42 <br /> / <br /> LICENSE ❑I[C-42 ❑':JC36 OTHER NUMBER / -� EXPIRATION DATE <br /> r� I1 <br /> WATER TABLE DEPTH: — ooft GEOGRAPHICAL INFORMATION: COord nates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: I NEW INSTALLATION R AIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-0F-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG 6wale 11576CAPACITY gal #OF COMPARTMENTS ;z <br /> GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS a` <br /> I � � <br /> DISTANCE TO NEAREST: WELL p7(90 T ft FOUNDATION ft PROPERTY LINE (60 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> (11111''' \ <br /> �l LEACH LINES 1 1 LEACHING CHAMBERS #OF LINES Cal LENGTH OF LINES (fC i-T ft <br /> DISTANCE TO NEAREST WELL a0 (.. <br /> ft FOUNDATION 10 r ft PROPERTY LINE IC? 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 ,ftL(FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER WIDTHp�`` '7 /I <br /> ft DEPTH ;15—/ ft <br /> DISTANCE TO NEAREST WELLyW r•� ft FOUNDATION C ft PROPERTY LINE lU 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 9/53-7697 <br /> SIGNED TITLE ll DATE <br /> -P WAHAT <br /> D <br /> 1 <br /> SA )A2U NTY <br /> EWRONIINTI� <br /> ANT <br /> )EPA RTMENT US ONLY �p <br /> Application Acceptedj24& Date 7 Area Z Employee ID# F(/(6 <br /> Final Inspection By Date '712- ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: r Pit/Sump Soil Character: <br /> COMMErrN--TS Q D Z7 . <br /> L T —!5;/ ,'h O <br /> r' _ sot( � Greo !� ha.+�e riders. <br /> PE SC Received h Amount 4ate Permit/ Invoice# Permit ID# �79 <br /> Code INFO B ash RemittedService Request# <br /> z 2 3 5� <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />