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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-KEFUNDABLE PERMIT y� GALL ZU'J V0J-/DY/ FOR INSPECTIONS LXPIREJS�T YEAR FROM UATE ISSUE <br />JOB ADDRESS S � LI I ri 11 CITY/ZIP U 43x' fV n <br />CROSS STREET La r r D VIA• APN i� � AJ I PARCEL SIZE 1 f <br />OWNER NAME 1 • �� 11/f V PHONE <br />OWNER ADDRESS IOJ �i .�i E�/tC 1�/' t/t /� GTY/STATE/ZIP /�}//]� <br />CONTRACTOR \ �I{..e/J t/t.<J�� /rc� I L' `y• PHONE ��/ I •53-9-713,614 <br />CONTRACTOR ADDRESS ('�� {`11Q./N YVb \1 CJ�• C� CITY/STATE21P t� , 2CIR 067AD <br />LICENSE -C-42 ❑uC•36 OTHER A NUMBER 915 1 ✓ EXPIRATION DATE <br />h! <br />w.-. —, I ---) 0 - F � L--...-..- <br />D <br />PERC TEST # BUILDING PERMIT # 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 WING UNITS: D NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br />It SEPTICTANK TYPE/MFG \ CAPACITY 12c�� gal #OFCOMPARTMENTS_� <br />❑ GREASETRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL 150 ft FOUNDATION IO + ft PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />EtI <br />LEACH LINES <br />LEACHING CHAMBERS Ctllg- Il rOL fOT 5 # OF LINES_ LENGTH OF LINES <br />t ft <br />DISTANCE TO NEAREST <br />WELL ,6Q R FOUNDATION tO ft PROPERTY LINE <br />G� <br />J ft <br />❑ <br />FILTER BED <br />WIDTH <br />ft LENGTH ft DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL ft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ <br />MOUNDED <br />WIDTH <br />ft LENGTH ft DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL ft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ <br />SUMPS <br />WIDTH <br />ft LENGTH ft DEPTH <br />it <br />DISTANCE TO NEAREST <br />WELL ft FOUNDATION ft PROPERTY LINE <br />It <br />❑ <br />DISPOSAL PONDS WIDTH <br />ft LENGTH ft DEPTH <br />It <br />DISTANCE TO NEAREST <br />WELL ft FOUNDATION ft PROPERTY LINE <br />ft <br />J <br />3 <br />SEEPAGE PITS <br />NUMBER .? <br />WIDTTHHy� ,t ft DEPTH <br />�7 <br />25 ft <br />DISTANCE TO NEAREST <br />WELL I7V ft FOUNDATION tot- ft PROPERTY LINE <br />L 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 />} ) VCf An I C IV IVJL VIYL1 <br />Application Accepted By - Date l cel Area �? Employee ID# <br />Final Inspection By Date Z6Z SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 /Ft: PIUSump oll Character: <br />COMMENTS j C( 30 1 7,11 y avve <br />00 <br />PE Sc Received Check#/ AmountPermit[Code INFO B ^Cash Remitted D e Service a uest # Invoice # Permit ID# <br />42-01 �P /I �„ q ONSITE WASTEWATER TRTMNT SYSTEM PERMfT <br />4/14/18 Y wl'✓•J �e-19,, <br />