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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> k SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205.(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 3 CITY/zr <br /> Q nM 2 M <br /> CROSS STREET /1S'�' ICY)/�.IyS. F--IYt� APN 0�6 3 16 PARCEL SIZE <br /> OWNER NAME Saffl Y 14111 PHONE v' <br /> OWNER ADDRESS nSc Y•I/��� L CITY/STATEIZI/Pj G <br /> CONTRACTOR \NOSE 04S,+ R Ck-hDf/, Inc PHONE 16 /- 3/�3 c1. 73q fQ L� a <br /> CONTRACTOR ADDRESS 33 ma Ywe I 1 E4• CITY/STATE/ZIP <br /> ✓��D1, �� -1 V <br /> LICENSE 1 C-42 ❑ C-36 OTHER NUMBER 115 EXPIRATION DATE V)2 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION '/ ve REPAIR/ADDITION ENGINEER DESIGNED/ TERNATIVE <br /> N k <br /> REPLACEMENT C OUT-OF-SERVICE SEPTIC SYSTEM I< DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE LI COMMERCIAL L. OTHER <br /> 1 NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: r�w-, NUMBER OF EMPLOYEES: <br /> IO SEPTICTANK TYPE/MFGP14 L-- CAPACITY 1(000 gal It OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION I It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMPP LLvv LL ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 1� LEACH LINES J LEACHING CHAMBERS J Y1i t I TTA f I rS W #OF LINES Z LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE_ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE N ST W TION ft PROPERTY LINE ft <br /> ❑ MOUNDED T ftmumT ft DEPTH ft Q <br /> ry <br /> T ETD UN ION ft PROPERTY LINE ft \ryt <br /> ❑ SUMPS c ft DEPTH ft <br /> NNWANC AREAVW WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> / DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINES ft <br /> Q' SEEPAGE PITS NUMBER L4 WIDTH M ft DEPTH ,61 ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION �� ft PROPERTY LINE S 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. L d <br /> SIGNED TITLE O w lYIATOY- DATE -1 <br /> ij <br /> I�ONT <br /> VSD <br /> 8 2021 <br /> I R-rAL <br /> ENT <br /> DEPARTMENTUSE ONLY <br /> Application Accepted By �� /��`� Date Area 'L- Employee ID#�(L <br /> Final Inspection By fff (dj Pl cS Data ❑ SPECIAL PERMIT•Approved by <br /> Character of Soil to Depth of 3 Ft: IVs mp Soil Character: <br /> COMMENTSFc� E jl lr,; lines 40 flennT,:In. <br /> PE SC Received Cha Amount Date Permit/ Invoice# Permit IDN <br /> Code INFO ash Remitted u # <br /> 437OTA411 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14118 <br />