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- t ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 NON-REFUNDABLE PERMIT CALL R409 953-7697 FOR INSPECTIONS EXPIRES 1 1YEAR FROM DATE ISSUE Joe ADDRESS d 'pr VL CITY/ZIP I I GT CROSSSTREET Cc- �APN n lu(-y:�e --f 6��- ✓_ y PARCEL SIZE '46 OWNER NAME PHON A�caPrIC OWNER ADDRESS, : "Ti�' A CITY/STATE/ZIP - w. CONTRACTOR L PHONE _ J CONTRACTOR ADDRESS Z 11 -NT \L- CITYISTATE/ZIP U1 LICENSE ❑7C-42 0-C-36 OTHER? NUMBER•7�fi817S� EXPIRATION DATE �i�•t./I '-�I'��I+� D WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: _ NEW INSTALLATION _ REPAIR/ADDrnON _ ENGINEER DESIGNED /ALTERNATIVE •ISTANCE To NEAREST _ REPLACEMENT _ OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS ft DEPTH DISTANCE To NEAREST: WELL It FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) PE SC I Received Check#/ Amount Dat Permit/ Invoice# Permit 1D# Code INFO B Cash Remitted Service Re uest# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 H ■ OF •ISTANCE To NEAREST WELL- It FOUNDATION ■ FILTER BED WIDTH ft LENGTH ft DEPTH ft •ISTANCE To NEAREST WELL- ft FOUNDATIONPROPERTY It Ll MOUNDED WIDTH ft LENGTH ft DEPTH It •FOUNDATION Ll SUMPS WIDTH ft LENGTH ft DEPTH It DISTANCE To NEAREST WELL It FOUNDATION it PROPERTY LINE_ It ■ DISPOSAL PONDSDEPTH It DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY DISTANCE To NEAREST WELL •. - ft FOUNDATION ft PROPERTY c ER HAVETIF44 1, ..EPfR . •• L BE � ACCORDANCEONE IN •.• ••• T: TATE LAWS AND RULES AND•- REGULATIONS•••• IN COUNTY. •�►VANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (2I' �N��- 1■■■■■■■■iii■■■■■■■■■■■■■■■■■■■t7�7 1■■■■■■■■■1■Il�Ii11■■■■■■■■■■■■■■iiif111iiilii'�i�■■■Ca 1■■■■■■■■■l��Ll�■11■■■■■■■■■■■■■11111�1�11_IIIAI■�RR!!!1�■■■■■ 1■■■■■■■■■ilii■■■It■■■■■■■■■■■■■Cii+lFilr►:i�IWF.�t�iWii■■■■■ 1■■■■■■■■■�■■■■■■■■■■■■■■■■■■iiidliiWliillrlillWr�■■■■■■ - TITLE 1-)fAJ k"V DATE �r13��i i■■■■■■ 7 � COMMENTS _ i1 •l r PE SC I Received Check#/ Amount Dat Permit/ Invoice# Permit 1D# Code INFO B Cash Remitted Service Re uest# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 H