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* ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE -STOCKTON CA 95205.(209) 468-3420 <br />NON-REFUNDABLE PERMIT C LL 209) 953-7697 FOR/NSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS O 1 vg- • '�% Clam' ry/LP <br />CROSS STREET _ APN Z4 2 036- <br />l PARCEL SIZE <br />OWNER NAME 1 A l f -f -M -I 1 W'L4 V i QL• PHONE <br />OWNER ADDRESS k 5a1 \ 1L (/{�7 A Uwe- CITY/STATE/LP �G� <br />CONTRACTOR W�sa' ,,2oas�(�� p c�,�kp-II�o2�. ln�• PHONE del m✓ i .-7,3 1G� <br />4 <br />CONTRACTOR ADDRESS 33 1\VJy�yVv YI c\�• 1 CRY/STATE/7JP �DA 1 Oft C67—LfU <br />LICENSE E C-42 L C36 OTHER NUMBER I l EXPIRATION DATE ? 0 <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # <br />I BUILDING PERMIT# <br />#OF LINES <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION <br />REPARIADDITION <br />ENGINEER DESIGNED /ALTERNATIVE <br />DISTANCE TO NEAREST <br />REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE <br />:1 COMMERCIAL <br />LJ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />O SEPTICTANK <br />TYPE/MFG <br />CAPACITY <br />gal #OFCOMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />R PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />O PKG TX PLANT <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />41, <br />LEACH LINES <br />LEACHING CHAMBERS 14, <br />6AADYC, <br />#OF LINES <br />�_ <br />LENGTH OF LINES OO) <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />_ft <br />PROPERTY LINE <br />ft <br />❑ <br />FILTER BED <br />WIDTH <br />ft <br />LENGTH <br />It <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />MOUNDED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH <br />f( <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />AJ <br />❑ <br />SUMPS <br />WIDTH <br />ft <br />LENGTH <br />It <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />W ELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />❑ <br />DISPOSAL PONDS WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY UNE_ <br />❑ <br />SEEPAGE PITS <br />NUMBER <br />Worm <br />ft DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNOATION <br />ft PROPERTY LINE <br />T HEREBY CERTIFY THAT 1 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 />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />102021 <br />IN C <br />y r NAY <br />�l <br />J <br />ol <br />v <br />