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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 <br /> FROM DATE ISSUED <br /> JOB ADDRESS O O t� CITY/ZIP <br /> t ,y (� 7 %i <br /> CROSS STREET 'rC'{� l 1 APN )CI 3 d 7 v /q nPARCEL SICZE ••� d <br /> OWNER NAMEyl��(*o7'0"'�.�� ��L0 PHONE 2 �^JAI�^ "� "� 9 <br /> OWNER ADDRESS <br /> (�_1 r�Lnln I C _\ CITY/STATE/ZIP <br /> CONTRACTOR (1,�)1`''r PHONE <br /> CONTRACTOR ADDRESS <br /> CITYISTATEIZIP <br /> LICENSE ❑7C-42 El 7C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: '1 —� ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# oio03CO7 LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION _ REPAIR/ADDITION _ ENGINEER DESIGNED(ALTERNATIVE <br /> REPLACEMENT _ OUT-OF-SERVICE SEPTIC SYSTEM _ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER <br /> ``OFBEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG C ^K�,, CAPACITY I gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS ) <br /> DISTANCE TO NEAREST: WELL O 0 ft FOUNDATION _ ft PROPERTY LINE^-Vy ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ftFOUNDATION It PROPE%Y, It <br /> 1� FILTERBED WIDTH t7_�ft LENGTH 3A ft DEPTH t�- n ft <br /> DISTANCETo NEAREST WELL 309' ft FOUNDATION S ft PROPERTY LINE��C/.y ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It 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 It 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 U=R ADVANC NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED D, TITLE DATE ZOZ� <br /> PA <br /> ft Y�E��' <br /> CE�VZQ <br /> AN ?0UV ?�?1 <br /> �RON/N C0UN <br /> HCFAry <br /> � <br /> X77z DEPARTMENT USE ONLY <br /> Application Accepted By G— /�� �'' Date U.'701,21 Area CACI Employee ID# jA— <br /> Final Inspection By A _ Data ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 t: Pit/S mp Soil Character: <br /> COMMENTS SeCjnC,4 l r C 14e), <br /> 4el )r� . )P rTr, !vim ;JP1/S I.) ,thin s��b�dc� de <br /> 1=Htn� <br /> LI f e a o rC�s <br /> PE SC Received Check Amount Date PermiU Invoice# Permit ID# <br /> Code INFO Remitted Service a uest# <br /> c <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />