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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 /> �T�PERMIT CALL 209 953-7697 FOR INSPECTIONS / EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS LG> � r� CITY/ZIP f� G G� J ' S^ (.7 <br /> CROSS STREET /1/ ��/(� C1 J!O i�{�r'(� i(� APN0 � 60 3 Q PARCEL SIZE 'r O 1 <br /> —� O <br /> T— O <br /> OWNER NAME ///c.����f ('�C�D I`/ PHONE 2;2- <br /> 'ld-� <br /> OWNER ADDRESSe /"�`i� CITY/STATE/ZIP I <br /> CONTRACTOR , r. �� S /v��.M/L� z�" �1i'.I PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP �G �l�✓ l' <br /> LICENSE 1111C-42 11FIC-36 OTHER NUMBERD EXPIRATION DATE <br /> �/ l^ <br /> WATER TABLE DEPTH: _C� ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: _ NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ LTERNATIVE <br /> IDi <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION c,M <br /> INSTALLATION WILL SERVE: ESIDENCE ❑ COMMERCIAL r2 ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: v NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG [� CAPACITY n J gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL J[J I—)- ft FOUNDATION ft PROPERTY LINE l7I' 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 ft FOUNDATION��� + ft PROPERTY LINE J 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 FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER �_- WIDTH --f , ft DEPTH <br /> DISTANCE TO NEAREST WELL��� ft FOUNDATION �1� � 7, 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 HOURUWANOt NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-76,97 <br /> SIGNED TITLEDATE <br /> 10 <br /> N <br /> /R <br /> OT <br /> F <br /> __=j L 4� <br /> DEPARTMENT.0 E ONLY <br /> Application Accepted By Date Area 4 ` Employee ID#� <br /> Final Inspection By Date LM 7- G SPECIAL PERMIT-Approved by <br /> Character of Soil to Deqth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS Fa I l?75 sglfro. Exi sh n6 )1)1� -IV "P a/Y7 <br /> ol <br /> PE SC Received #/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By ash Remitted ej Service Re uest# <br /> a)o 1 p <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />