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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 PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 11 YEAR FROM DATE ISSUEI <br />JOB ADDRESS h CITY/ZIP <br />CROSS STREET PAR <br />APN U �7c��oa3 �— <br />/ CEL SIZE <br />OWNER NAME_fl//� 2/� Ji14 �PHONE ,Fq <br />OWNER ADDRESS� / CITY/STATE/ZIP <br />CONTRACTOR_ /S /( Gti/.Y�/��51 U%Li�� 44, PHONE ey l51 <br />CONTRACTOR ADDRESS U22//(/y i� /` CITY/STATE/ZIP <br />LICENSE ❑❑C-42 ❑❑C-36 OTHER NUMBER �� r EXPIRATION DATE. <br />WATER TABLE DEPTH: '-0-2'0 ft GEOGRAPHICAL INFORMATION <br />❑ PERC TEST # BUILDING PERMIT # <br />TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADI <br />Coordinates X <br />Y <br />LAND USE APPLICATION # <br />❑ ENGINEER DESIGNED <br />❑ REPLACEM IF <br />NT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br />INSTALLATION WILL SERVE: ESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />TERNATIVE <br />❑ SEPTIC TANK <br />❑ GREASE TRAP <br />❑ LIFT STATION <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE OF PUMP <br />ft <br />CAPACITY <br />CAPACITY <br />FOUNDATION <br />❑ PKG TX PLANT <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />*--LEACH LINES <br />❑ LEACHING CHAMBERS <br />i/ <br /># OF LINES <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST <br />WELL �C/ <br />ft <br />FOUNDATION <br />/d <br />ft PROPERTY LINE J l� ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINEft <br />/� SU MPS <br />V <br />WIDTH ft LENGTH <br />,/ <br />�b <br />ft <br />DEPTH ��" ft <br />� <br />DISTANCE TO NEAREST <br />WELL /7(i 4. <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />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 />i <br />Final Inspection By ew-- 6.7 Date l,-3 — 27 ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS oilhi6. 5Y5-�ew.. sys-F wl oil P,tIS},I'1� )off. SuMDS <br />bids Cave -}o 1;M4Fd' source �4 e�'cos^,�er �. �iPI Fv t,i, +I.bf" a� <br />PE <br />Code <br />SC <br />INFO <br />Received he <br />BV Cash <br />Amount Date <br />Remitted <br />Permit/ Invoice # <br />Se ice Re uest # <br />Permit ID# <br />I010 <br />RIDO rT Z <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />T <br />y <br />d <br />d <br />