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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 GALL ZU1 10JJ--110101 FOR INSPECTIONS tXPIRES "I TEAR FROM DATE ISSUE <br />JOB ADDRESS I N. LbVQef &0agugh P- - CITY/ZIP2 WOO brige <br />CROSS STREETDoll b^rill APN �+v PARCEL SIZE <br />OWNER NAME W O lVV .d PHONE/ r ) �j <br />OWNER ADDRESS <br />I�' nI �' J /•�/���L(�'� rr�I�'{-).1 1�- 1��((��1y�'" Ire I CITY/STATEIZIP 1AA ��l (^ (1 ". \._> C <br />CONTRACTOR <br />y VW�2L,tJf/t�J�/,� `W 1�eG/�-710�. \ YIG . PHONE O LOW <br />(��1y,J•����j� I,.� <br />CONTRACTOR ADDRESS ✓� 1' 1" �X'yT'eI ' C 1 �I CITY/STATE21P LVD 1 SIJ 2C rl (' 52- IO <br />LICENSE C-42 C-36 OTHER A NUMBER J 115 1 EXPIRATION DATE zu") <br />WATER TABLE DEPTH: 3c)--30 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />3 <br />PERC TEST # <br />SC <br />BUILDING PERMIT# ul G1 LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION <br />REPAIR/ADDITION <br />ENGINEER DESIGNED /ALTERNATIVE <br />Remitted Service Request # <br />REPLACEMENT <br />OUT -0F -SERVICE SEPTIC SYSTEM <br />DESTRUCTION <br />INSTALLATION WILL SERVE: VIRESIDENCIF COMMERCIAL <br />OTHER <br />NUMBER OF LIVING <br />UNITS: <br />NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />SEPTIC TANK <br />TYPE/MFG L <br />CAPACITY <br />�J <br />gal # OF COMPARTMENTSy <br />❑ GREASETRAP <br />TYPE/MFG <br />CAPACITY <br />gal #OF COMPARTMENTSC <br />DISTANCE TO NEAREST: <br />WELL 1 W I ft FOUNDATION I D I <br />ft PROPERTY LINE ✓ I ft <br />3LIFT STATION <br />SIZE TYPE <br />OF PUMP ❑ PKG TX PLANT L]SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />51LEACH LINES <br />LEACHING CHAMBERS th (NS # OF LINES 2. <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST <br />WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />fl LENGTH It <br />DEPTH ft <br />ELL <br />DISTANCE TO NREST <br />WE t1 <br />ft PROPERTYLINEft <br />/ <br />SUMPS C'3 <br />WIDTH <br />'FOUNDATION <br />ft LENGTH I W ft <br />DEPTH A ft <br />DISTANCE TO NEAREST <br />WELL—A5—G ft FOUNDATION 1C) <br />It PROPERTY LINE S ft <br />❑ DISPOSAL PONDS <br />WIDTH <br />ft LFNGTIi It <br />DEPTH ft <br />DISTANCE To NEAREST <br />WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />El SEEPAGE PITS <br />NUMBER <br />WIDTH It <br />DEPTH ft <br />DISTANCE To NEAREST <br />WELL ff FOUNDATION <br />It 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 />IN <br />DEPARTMENT US ONLY <br />F Application Accepted By �_ — r Date - -i Area �% CI Employee ID#z <br />Final Inspection By 1,4/,f) Date C SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 F PIVSump Soll Character: <br />COMMENTS I )=':, r r: , TI PY <br />PE <br />SC <br />Received Check#/ <br />Amount ate Permit/ Invoice # PermitID# <br />Code <br />INFO <br />Cash <br />Remitted Service Request # <br />I �► 3 <br />I I <br />�S <br />S?I 2)"Sy Icig <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114118 <br />IENT <br />IVED <br />9 2021 <br />N COUNTY <br />MENTAL <br />DARTMENT <br />