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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 ZU9 953-/69/ FOR INSPECTIONS tXPIRES l YEAR FROM DATE ISSUE <br />JOB ADDRESS C CITY/ZIP (/��X <br />CROSS STREET V\/ <br />/� // - � L ]yJ� APIN I Z 0 D PARCEL SIZE 2' (OS <br />OWNER NAME v v I ` 1 —s � np�/ 1 � I ( PHONE <br />OWNER ADDRESS Ac, � 1e) V� CITY/STATE/ZIP <br />CONTRACTOR �/JD�C� �� `d 7 r -� J C �✓ f n PHONEJ'�1 <br />CONTRACTOR ADDRESS %/fes l/ Z `� �� — r CITY/STATE/ZIP s"/��%% C / J -y- <br />LICENSE <br />)� <br />LICENSE [ILC-42❑CIC-36 OTHER -114 NUMBER yJJ EXPIRATION DATE 7 'Z- 1 <br />WATER TABLE DEPTH: 45 5 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: I I. NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL C OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />7 <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST WELL <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS <br />Amount Date Permit/ Invoice # <br />Remitted %ervice Request # <br />Permit ID# <br /># OF LINES <br />151 <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />91 FILTER BED <br />WIDTH / (: r ft <br />LENGTH <br />� <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />I-% J <br />ft <br />FOUNDATION <br />/J <br />ft PROPERTY LINE S ft <br />❑ MOUNDED <br />WIDTH ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />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 />SIGNED <br />Application Accepted By ` <br />Final Inspection By <br />Character of Soil to Del6f6 ofFY <br />COM ENTS 0UfR <br />X; (Ito r 413 <br />VIZ 11r1jr-LV I IWOV12 - r -LL -J -10L 11P1LLJ <br />TITLE Citi f �O/ DATE 57/,/ S Z'37 <br />EPARTMENT USE 0,NL Y '�! �� C <br />Date � .� Z / Area ( Employee ID# J <br />1 Date C SPECIAL PERMIT -Approved by <br />Pit/Sump Soil Character: <br />1'0 f fe.-c e- CG i L <br />mi 4 0 77z — Rq9 -fir rw-er ince-i <br />PE SC <br />Code INFO <br />Received Check#/ <br />B Cash <br />Amount Date Permit/ Invoice # <br />Remitted %ervice Request # <br />Permit ID# <br />151 <br />I .z U <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />