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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 P RMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />I <br />JOB ADDRESS ?' j--, "'CU ,nib CITYIZIP Lo-,> C,l ZLIrr,i <br />CROSS STREET L ir.9(+ j-- LN A P N PARCEL SIZE_ <br />OWNER NAME jdi R1 C 7'/[1�I�O�ti[10 PHONE <br />OWNER ADDRESS <br />CITY/STATEMP <br />rr <br />CONTRACTOR I -E (C/v`jl l�Ll l_TSE�� ) J��/rL, LN/- PHONE ISI1/) 7- y1 a7 <br />CONTRACTORADDRESS <br />05!7 ani%Isr+l/ C."'CcK eQ fF 20'7 CITYISTATEIZIP <br />LICENSE (/ 422 <br />OTHERNUMBER 7�Zy3� EXPIRATION DATE V(/ISCI 12 C -= Z <br />WATER TABLE DEPTH: <br />'C-36 <br />�� <br />U 12 V ft GEOGRAPHICAL INFORMATION: C.1"dlnateS X Y <br />PERC TEST # <br />BUILDING PERMIT #Po LAND USE APPLICATION # <br />TYPE OF WORK: <br />New INSTALLATION R&AdRIADDrnON ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: VIRESIDENCE COMMERCIAL OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br />—/ <br />2 SEPTIC TANK <br />(pJ <br />TYPEIMFG TTL ��bNt�k >fQ CAPACITY ZOO gal #OFCOMPARTh1ENTS Z <br />❑ GREASE TRAP <br />TYPE/MFG CAPACITY gal # Or CCVPARTMENTs <br />DISTANCE TO NEAREST. WELL R FOUNDATION R PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />_ r <br />✓LEACHING CHAMBERS /nFI*�'fW #OF LINES 3 LENGTH OF LINES SS It <br />DISTANCE TO NEAREST WELL 00 ft FOUNDATION �- It PROPERTY LINE 1 S 1 ft <br />❑ FILTER BED <br />WIDTH It LENGTH R DEPTH R <br />DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br />❑ MOUNDED <br />WIDTH R LENGTH R DEPTH ft <br />DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE R <br />❑ SUMPS <br />WIDTH ft LENGTH It DEPTH It <br />DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br />❑ DISPOSAL PONDS WIDTH R LENGTH R DEPTH R <br />DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />�// <br />L9 SEEPAGE PITS <br />NUMBER WIDTH x112 11ft DEPTH 2 S ft <br />DISTANCE TO NEAREST WELL / S -D ' ft FOUNDATION 70' ft PROPERTY LINE 1 S r 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 />SIGNED 1�2' ttl TITLE DATE 031 7/'=4,2-1 <br />EPARTMEN I UA E OA L Y ww <br />Application Accepted By %V Dale Area Employee ID# <br />Final Inspection By ! Date2 Z SPE IAL PERMIT - Approved by <br />Character of Soll to Depth of 3 Ft' Pit/Sump Soll Character: <br />COMMENTS �y <br />PE SC Received Check## <br />Code INFO B C <br />Amount Date PermlV Invoice # Permit ID# <br />Remitted Se Ice R uest # <br />l <br />42-07 � { iJL-� &V/ /� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114/18 <br />