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0 <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 P/ER-7MIT CALL (209) 953-7697 FOR INSPECTIONS / EXPIRES 1 YEAR FROM DATE ISSUED <br />/ <br />JOB ADDRESS L/ P /';4-1 6,4- r CITY/ZIP <br />CROSS STREET ! )L7/79itJLi LxJ APN e)P Ste_ C -?Q r PARCEL SIZE <br />r i <br />OWNER NAME_ i <br />_ PHONE <br />1, /`M_J&�pOY/I�L� <br />OWNER ADDRESS Z�SI <br />I A x L <br />(F�1�-JOIE/�/ CITY/$TATE(ZIP 7js� <br />CONTRACTOR �<'/0 <br />y1 L 1/Y, •!1�/�� PHONE <br />Permit/ <br />Service Request # <br />Invoice # <br />CONTRACTOR ADDRESS��, <br />6YiJL`C/�'c��z YJ%//cam l7/� CITY/STATE/ZIP <br />LICENSE 1106-42 ❑❑C-36 OTHER NUMBER yS`fUySEXPIRATIONDATE !' G '? <br />WATER TABLE DEPTH <br />v� 7� ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # <br />BUILDING PERMIT # J SrO Sb �% LAND USE APPLICATION #VA <br />TYPE OF WORK: <br />NEW INSTALLATION ❑ REPAIR/ADDITION 07,_ ENGINEER DAISIGNED /ALTERNATIVE <br />❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM n DESTRUCTION <br />INSTALLATION WILL SERVE: �4- RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 4 NUMBER OF EMPLOYEES: <br />�- SEPTIC TANK <br />TYPE/MFG t CAPACITY 7-1600 gal # OF COMPARTMENTS 'e <br />❑ GREASE TRAP <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />6�- LEACH LINES <br />❑ LEACHING CHAMBERS # OF LINES LENGTH OF LINES Ss ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION SO ft PROPERTY LINE % 5 ft <br />C FILTER BED <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />Q MOUNDED <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />® SUMPS <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL FOUNDATION ft PROPERTY LINE ft <br />ig SEEPAGE PITS <br />/ft <br />NUMBER WIDTH -3G II ft DEPTH '2S 1 ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION G ` ft 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 />IVIllvIfflIUIVI 40 nLlur'C HIJVH/VI.0 IVVi A -r- me Ulml:U rLirN 11VarCl. 1 IL/Iva - rLCHJC UMLL Izu, <br />SIGNED f/���. �— TITLE 7 >G DATE <br />D ARTMENT LPSE BNLY ��%% <br />Application AcceptedO t�By Date Area Employee ID#_Mc <br />Final Inspection By 'C��\_._/— Date Z I Z ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Su np Soil Character: <br />COMMENTS'jkjfjji�''!/l��_ AUM._ 1 <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />NCbecko <br />Cash <br />Amount <br />emitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />pan �I <br />gy- <br />42-41 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT" <br />4/14/18 <br />