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J,A_� <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />IVUN-Mtl-UNUlABLt/ rt.Hmi I <br />TYPE/MFG }'� �- <br />(-FILL [UU FOR INSPECTIONS <br />tXPIRES 1 YEAR FROM DATE ISSUEI <br />JOBADDRESS 1 V �E'Tj <br />(^ <br />J <br />e&Z)J-IDYf <br />s� }-.cr �yI�I }L_ �A i�� <br />CITY/ZIP :S 36r, 61 G� <br />ft DEPTH ft <br />CROSS STREET �nS Sr, er <br />40 <br />APN <br />� � -' ;L C)-->^ , S <br />PARCEL SIZE <br />GI, l� <br />OWNER NAME � / 3 NO) <br />61 <br />I ., � ! to i1 <br />DISTANCE TO NEAREST <br />PHONE <br />FOUNDATION / 6� ft PROPERTY LINE 7 S ft <br />OWNER ADDRESS 1-7 :24 <br />L' n P, -p' <br />�$E RCS <br />CITY/STATE/ZIP <br />CONTRACTOR yI' ► , I[, -' S <br />--r- <br />PHONE LIS-(, <br />-,-) �4 1;7- <br />CONTRACTOR ADDRESS r�`' <br />�rY <br />/b <br />l(' S L> <br />CITY/STATE/ZIP <br />,d <br />ki^1"t-y4ez-// '1 4rj <br />Cj <br />LICENSE ❑❑C-42 11❑C-36 OTHER <br />NUMBER <br />EXPIRATION DATE <br />PV�� <br />WATER TABLE DEPTH: GO -70 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT #_Ala LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br />INSTALLATION WILL SERVE: 1; --RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />SEPTIC TANK <br />TYPE/MFG }'� �- <br />CAPACITY )L 6 (7 gal <br /># OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY gal <br /># OF COMPARTMENTS <br />ft DEPTH ft <br />DISTANCE TO NEAREST: WELL O 6�- <br />ft FOUNDATION r nI ft <br />PROPERTY LINE 7 S ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ SAND OIL <br />SEPARATOR (ENCLOSED SYSTEM) <br />W LEACH LINES ❑ LEACHING CHAMBERS <br />❑ FILTER BED <br />❑ MOUNDED <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WELL 1 4�,O Ot- ft <br />ft LENGTH <br />WELL ft <br />ft LENGTH <br /># OF LINES <br />FOUNDATION 161 ft <br />ft DEPTH <br />ft PROPERTY LINE <br />ft DEPTH <br />FOUNDATION <br />LENGTH OF LINES <br />PROPERTY LINE 75 <br />WELL ft FOUNDATION ft PROPERTY LINE <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />❑ SUMPS WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />SDISTANCE TO NEAREST <br />WELL// ft <br />FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS NUMBER 3 <br />WIDTH LI/} /� <br />ft DEPTH �-S I ft <br />DISTANCE TO NEAREST <br />WELL 1 � 1 ft <br />FOUNDATION / 6� ft PROPERTY LINE 7 S 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 />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■r■■■■■ii�1■l►I■■■iii�:v■■■■■1 rTS!r1.T <br />DEPART <br />Application Accepted By..Employee <br />Final Inspection B Date E SPECIAL PERMIT -Approved by <br />Character of Soil to D-pth J3 Ft: Pit/Sump Soil Character: <br />• ' It <br />PE SC Received he / <br />Code INFO By Cash <br />Amount ate <br />Remitted <br />Permit/ <br />Service # <br />Invoice # Permit ID# <br />W7il- 15 t3169-+ <br />s g, 3 2) <br />-Request <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />