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j I 1 <br />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 �y GALL <br />JOB ADDRESS P-45PL J�J`p <br />O %� oet (//G <br />CROSS STREET 6 ///�� Coll 00, <br />JbJ-/bY1 FOR INSPECTIONS tXPIRES "I YEAR FROM UATE ISSUEI <br />CITY/ZIP <br />APN PARCEL SIZE R1 00 <br />OWNER NAME S A! F S LL,(- PHONE ^� <br />OWNER ADDRESS P0 <br />4 � OX /� � CITY/STATE/ZIP 1--0C� <br />�� <br />CONTRACTOR VLA } vad" C PHONE <br />CONTRACTORADDRESS J y 1[Q �1-te v/" CITY/STATEIZIP ✓ if//L+7 �s �� / <br />,f� � L(� h <br />LICENSE El�I\C-42 ❑CIC -36 OTHER NUMBER 1/510Y,5: EXPIRATION DATE - 3 <br />WATER TABLE DEPTH: c0 -70 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # d_ Obi 1)3 LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION 1.1 REPAIR/ADDITION n ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT U OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br />INSTALLATION WILL SERVE: XRESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />!❑` <br />❑ <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG 4e" -0&4l - / <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL / SO ft <br />SIZE TYPE OF PUMP <br />CAPACITY gal gal # OF COMPARTMENTS_ `Z <br />CAPACITY gal # OF COMPARTMENTS <br />FOUNDATION fO ft PROPERTY LINE (60 -ft <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />Dae <br />LEACH LINES <br />❑ LEACHING CHAMBERS <br />Permit ID# <br />I -0i 1 <br />i <br /># OF LINES C LENGTH OF LINES f S ft <br />�si?'-I <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION ' ft PROPERTY LINE Q ' ft <br />❑ <br />FILTER BED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ <br />MOUNDED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ <br />SUMPS <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ <br />DISPOSAL PONDS <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS <br />NUMBER <br />WIDTH �6y <br />// ft DEPTH CP5 ft <br />DISTANCE TONEAREST <br />WELL %SO "-}- <br />ft <br />FOUNDATION �%O Z ft PROPERTY LINE �� Z ft <br />T 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 <br />DATE P-5--0 <br />DEPARTMENT U E ONLY —� <br />Application Accepted By —77 L Date I► Area Employee ID# <br />Final Inspection By 40 Date Wl W 262V ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS /JP,L.I $ F -ri Flt- I <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check#/ Amount <br />s Remitted <br />Dae <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />I -0i 1 <br />11 -7 <br />�si?'-I <br />1 S <br />Liq S'q'- <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />