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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-KEFUNDABLE PERMIT (;ALL LUU yJ3-/Dy/ FOR INSPEGTIONS CXPIKt5 I TtAK t-KUM UAIt ISSUtU <br />JOB ADDRESS 7q 6'C CITY/ZIP <br />%� ed) <br />CROSS STREET 61111 F APN O v 1 I 1 O 1/ ( PARCEL SIZE la -3 <br />z <br />OWNER NAME � ^ PHONE T (/ Z J <br />OWNER ADDRESS SG f, l,,^ ,'e CITY/STATE/ZIP <br />CONTRACTOR Septic Services Group PHONE 916-203-6259 <br />CONTRACTOR ADDRESS PO Box 569 <br />CITY/STATE/ZIP Wilton, CA -95693 <br />LICENSE - C-42 _ C-36 OTHER A NUMBER 1068208 EXPIRATION DATE 8-31-2022 <br />WATER TABLE DEPTH: /0 y V ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />- PERC TEST # <br />I BUILDING PERMIT # <br />LENGTH OF LINES ft <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION <br />REPAIR/ADDITION <br />ENGINEER DESIGNED /ALTERNATIVE <br />DEPTH ft <br />REPLACEMENT <br />OUT -OF -SERVICE SEPTIC <br />SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE <br />0 COMMERCIAL <br />OTHER <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINE It <br />❑ SUMPS <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: q <br />NUMBER OF EMPLOYEES: <br />SEPTICTANK <br />TYPE/MFG <br />CAPACII <br />_ gal #OFCOMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />DISTANCE TO NEAREST: WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />0 LIFT STATION <br />SIZE TYPE OF PUMP <br />0 PKG TX PLANT <br />0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />LEACHING CHAMBERS # OF LINES /— <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION (J` <br />ft PROPERTY LINE /O O ft <br />❑ FILTER BED <br />WIDTH ft LENGTH ft <br />DEPTH ft <br />DISTANCE To NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH ft LENGTH ft <br />DEPTH It <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINE It <br />❑ SUMPS <br />WIDTH It LENGTH It <br />DEPTH It <br />DISTANCE TO NEAREST WELL It FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS <br />WIDTH ft LENGTH It <br />DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINE ft <br />SEEPAGE PITS <br />NUMBER I WIDTH ft <br />DEPTH Z `J It <br />DISTANCE TO NEAREST WELL t!5V ft FOUNDATION O <br />ft PROPERTY LINE 50 It <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 />MINIMUM48tiQ <br />ADVANCE NOTICE REQUIRED FOR INSPECTIONS- L ASE CALL 209 953-769 <br />SIGNED <br />TITLE /7-& E <br />DATE IO `I Z — <br />l DEPARTMENT USE ONLY qtq <br />Application Accepted B jvL Date �d Area y r / Employee ID#F& <br />Final Inspection By — � J LDate W � 8 IZ i1 SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS �c1_ I I� QrVt.,Y�s�th�i �1Y1Fs �o yeyvfctln <br />PE SCReceived Chec{ #/ Amount D to Permltl Invoice # Pefmit ID# <br />Code INFO Cash Remitted Se iceRe u St# <br />�dILD I ;IS GA -I IIIA12.12ii e I) <br />4 -018 C�� �{,1 ' 3 3 0 '1,( -?-(, 6 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />W <br />NT <br />