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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTDN AVENUE-STOCKTON CA 95205 • (2D9) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSIIFn <br />JOB ADDRESS _y-All4y/�} <br />CROSS STREET 1✓, y�`. <br />OWNER NAME VI l• Ci <br />CITY72r <br />APN _ o L U - r) < PARCEL SIZE V <br />OWNER ADDRESS 1, n ` (� CITY/STATEIZIP <br />CONTRACTOR ti\�([.\���jj��� A/Q�� yth�'e� Inc, '✓ • PHONE /'� [� -7 � <br />CONTRACTOR ADDRESS 133 (I LLl-h N � � I LC'� CITYISTATFJZP �/�' CA - { 5,f'/ O <br />LICENSE C-42 _' C-36 OTHER_ NUMBER ( EXPIRATION DATE 202-3 <br />WATER TABLE DEPTH: <br />_ PERC TEST # <br />TYPE OF WORK: <br />fl GEOGRAPHICAL INFORMATION: Coordinates X Y <br />BUILDING PERMIT # LAND USE APPLICATION # <br />NEW INSTALLATION V REPANIADDITKON ENGINEER DES_IGNED.I-LTERNAT- <br />IVE <br />REPLACEME OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION 4LSL^� <br />INSTALLATION WILL <br />SERVE: RESIDENCE COMMERCIAL <br />OTHER <br />NUMBER OF LrvING <br />UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />/ <br />0 SEPTIC TANK <br />n <br />TYPE/MFG T I L CAPACITY ._I L -OD <br />_ gal # OF COMPARrMFNI S�_ <br />❑ GREASETRAP <br />TYPE/MFG CAPACI I <br />gal #oFCOMPA.RTMENrS <br />DISTANCE TO NEAREST: WELL SO it FOUNDATION ID <br />ft PROPERTY LINE <br />❑ LIFT STATION <br />___�ft <br />SIZE TYPE OF PUMP (3 PKG TX PLANT t] SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS # OF LINES <br />LENGTH OF LINES it <br />/ <br />DISTANCE TO NEAREST WELLft FOUNDATION <br />ft PROPERTY LINE ft <br />,1-[1l FILTER BED <br />WIDTH 2c) ft LENGTH 9 b <br />_ ft <br />DISTANCE TO NEAREST WELL��' 1 it FOUNDATION liQ <br />DEPTH ft <br />it PROPERTY LINE .r3 ft <br />❑ MOUNDED <br />WIDTH ft LENGTH it <br />DEPTH it <br />DISTANCE TO NEAREST WELLft FOUNDATION <br />R PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH it LENGTH it <br />DEPTH IT <br />DISTANCE TO NEAREST WELLIt FOUNDATION <br />R PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH it LENGTH it <br />DEPTH <br />DISTANCE TO NEAREST WELL R FOUNDATION <br />ft <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER WIDTH It <br />DEPTH <br />DISTANCE TO NEAREST WELL it FOUNDATION <br />ft <br />ft PROPERTYLINE ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE "SAN JOAQUIN COUNTY ORDINANCES. <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MIMMMIUMUR <br />SIGNED <br />ADVANGF NOTICE REQUIRED 1'"PEAS"r-Al <br />�vL0�7' TITLE \f! •CYS['ri-N <br />1209)953-7697 <br />DATE <br />RF yMF <br />MAY2020 <br />; (?1 21 <br />*O Q%/)v <br />RTj�ENT <br />Application Accepted v <br />Final Inspect!.. By <br />Character of Soll tJo�Dep/ of 3 Ft: <br />COMMENTS �G lsf if�6 <br />Y Area Employee 10# <br />FL <br />SPECIAL PERMIT -Approved by <br />Soil Character: _ <br />PE SC Received Check#/ Amount �Servlce <br />tU <br />Code INFO B Ce Remitted Dale uest # Invoice #Permit ID# <br />O <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114/18 (!W— <br />'J� -SSKIO J� <br />