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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-9420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESSpj� is <br />CITY/ZIP_ n L1 e n <br />CROSS STREET ET w 1 ( • APN, 09 S J -7 / PARCEL SIZE <br />OWNER NAME V- SanchPL <br />PFIONE <br />OWNER ADDRESS <br />CONTRACTOR J?S} 00a&�aCk-h� tnG PHONEL.O_7-,3,1'7 •+7 3 p <br />CTI/STAT_E?FP <br />CONTRACTOR ADDRESS fila Lj9. CTY/STATizp J„GI,0q• t�2p"f1TV <br />LICENSE L=C -42 --.C.366 OTHERNUMBER F015-1 EXPIRATIONDATE 2QZ3�1I <br />WATER TABLE DEPTH: 1,/ 1�:7 ft GEOGRAPHICAL <br />INFORMATION: Coordinates x <br />Y <br />❑ PERC TEST # BUILDING PERMIT # e? 7 ”) i LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION - REPAIR/ADDITION <br />_. ENGINEER DESIGNED IALTERNATNE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM <br />- DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE 0 COMMERCIAL <br />❑ OTHER <br />NUMBER OF LIVING UNITS: 'Iyc <br />NUMBER OF BEDROOMS: i <br />NUMBER <br />,./ <br />id SEPTICTANK TYPE/MFG Y CAPACITY �lebh <br />OF EMPLOYEES: r� <br />9ai # OF COMPARTMENTS L� <br />❑ GREASE TRAP TYPEIMFG CAPACITY <br />gal # OF COMPARTMENTS <br />II�� IL <br />DISTANCE TO NEAREST: WELL ft FOUNDATION �Vl l <br />L. <br />��1 ft <br />ft PROPERTY LINE <br />_y5 <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />OI LEACH LINES LEACHING CHAMBERSITA't T(A,�DCS OF LINES J <br />LENGTH OF LINES It <br />1 <br />DISTANCE TO NEAREST WELL ICO\ ft FOUNDATION 1�I+ <br />ft PROPERTY LINE `[]t + ft <br />❑ FILTER BED WIDTH ft LENGTH ft <br />DEPTH It <br />DISTANCETO NEAREST WELL It FOUNDATION <br />ft PROPERTY LINE It <br />❑ MOUNDED WIDTH ft LENGTH ft <br />DEPTH It <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS WIDTH ft LENGTH It <br />DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINEft <br />E3 DISPOSAL PONDS WIDTHft LENGTH ft <br />DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />'2� <br />It <br />It PROPERTY UN= ft <br />lid SEEPAGEPITS NUMBER WIDTH ��I <br />ft <br />DEPTH t <br />DISTANCE aTO NEAREST WELL �_ ft FOUNDATION i � t <br />11-1 <br />� �' .— �� <br />ft <br />ft PROPERTY LINE � t ft <br />I HEREBY CERTIFY THAT 1 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 />/ DEPARTMENT USEONLV <br />Application Accepted -�L_C DateC;iv Ins <br />Area y G � Employee ID# <br />Final inspection By <br />Date ?••?L C SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 F : -71;Pit/Sump Soil Character: <br />COMMENTS l'c�3'2� r' <. Pk, �ru . <br />PE SC Received Check#I Amount Permit/ <br />Code INFO Cas Remitted Date j e Request # Invoice # Permit ID# <br />42-01 <br />' 411411 � n � / � / ONSITE WASTEWATER TR7MN7 SYSTEM PERMIT <br />2021 <br />COU <br />NT y <br />T MFNr <br />