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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 /6,.333 S GA w2 E-NGV &.dAD CITY/ZIP E5C,4L0,V ��3o2D <br /> CROSS STREET H&T-14wi( APN_�a9^0� 1 PARCEL SIZE <br /> OWNER NAME f VROAI45 e,,4AAF2 PHONE / <br /> OWNER ADDRESS Z 3 3 3 S• Z-AWie5AfCE �^t2 CITY/STATE/ZIP ES L��iQ l d e4 CAn����a <br /> CONTRACTOR E GDRISGlGT/it/Gi PHONE o�O9^�UZ^I6 .2 <br /> © 7 Q i <br /> CONTRACTOR ADDRESS \ • O Y o K 7� l CITY/STATE/ZIP �U//RL OGfG. CA S <br /> RR <br /> LICENSE ❑EC-42 1111C-36C- <br /> C-36 OTHER /ZCE NUMBER 76- TI <br /> EXPIRAON DATE /30/e2ORA <br /> WATER TABLE DEPTH: �'�CJ ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 11 NEW INSTALLATION REPAIR/ADDITION I 1 ENGINEER DESIGNED/ALTERNATIVE <br /> I i REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I 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 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 ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ <br /> LEACH LINES i-; LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FIiLTER 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 FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL 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 /> MINI 48 H VANCE NOTICE REQUIRED FOR INSPECTIONS PL <br /> TIONS- ,E SE CALL 209 953-X77697 <br /> SIGNED TITLE`i//Y/L ENGINEEJZ DATE 7-9 7^ 21 <br /> F <br /> DEPARTMENT USE ONLY <br /> Application Accepted By A Date 7 d7 d ' Area 9C Employee I <br /> Final Inspection By 7� Date >-) ❑ SPECIAL PERMIT-Approved <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: RA <br /> COMMENTS <br /> 1021 <br /> E/VI/j VIN CO <br /> PE SC ReceivedChec Date Amount Permit/ rp <br /> Code INFO B ash Remitted Service R Invoice# Pe <br /> Request# ANT <br /> 21 tIS72 2 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />