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t y <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 <br />JOB ADDRESS 20135 Little John Road <br />CROSS STREET Oakwood or Van Allen <br />OWNER NAME Jerry & Tracy LaBarber <br />OWNER ADDRESS 20157 Little John Road <br />&0J -/Dy/ FUR /NSPE'G11UNS CAVIKts I i LAK r'KUm UAI L MOULT <br />CITY/ZIP Stockton CA 95215 <br />APN 185-080-54 <br />PARCEL SIZE 2.5 acres <br />PHONE 209 946-9882 <br />CITY/STATE/ZIP Stockton, CA 95215 <br />CONTRACTOR TBD {' le.L�_S .S 64 14 Zs e - �-v_ ✓� PHONE <br />CONTRACTOR ADDRESS PC) CITY/STATE/ZIP /{i 1 G �:1►L:/r� L V'' <br />LICENSE ❑ X-42 ❑ CIC -36 OTHER NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # BP -2104775 LAND USE APPLICATION # <br />TYPE OF WORK: -�k4 NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT CI OUT -OF -SERVICE SEPTIC SYSTEM _ DESTRUCTION <br />INSTALLATION WILL SERVE: fr- RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: 1120 sgft NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br />gFPTIf TANK TvaF/MFa 10 -L (w—, -A / CAPACITY 1600 qal # OF COMPARTMENTS_ <br />❑ <br />GREASE TRAP TYPE/MFG <br />CAPACITY gal # OF COMPARTMENTS <br />Check#/ <br />Cash <br />Amount <br />Remitted <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ <br />LIFT STATION SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />AfT1 <br />LEACH LINES I -LEACHING CHAMBERS <br /># OF LINES 3 LENGTH OF LINES <br />ft <br />DISTANCE TO NEAREST WE�59 <br />ft FOUNDATION ft PROPERTY LINE 120 <br />ft <br />❑ <br />FILTER BED WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ <br />MOUNDED WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO -NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ <br />SUMPS WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ <br />DISPOSAL PONDS WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE <br />ft <br />i <br />SEEPAGE PITS NUMBER -- WIDTH yi <br />t ft DEPTH i� <br />ft <br />DISTANCE TO NEAREST WELL �� r <br />ft FOUNDATION l �3 i ft PROPERTY LINE ft <br />I 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 />MINIMUM 48 H12UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953- 697 <br />SIGNED <br />TITLE el JA": '" r DATE <br />-7� DEPARTMENT USE ONLY <br />Application Accepted By Date (7 c7 Area �T Employee ID#_ <br />Final Inspection By Date 'b I jL1-\ ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS Eecoiid un/'r, P(;Me14gck)fes 901S-7_ �,t?r <br />PE <br />Code <br />SC <br />INFO <br />Received <br />A Ily I <br />Check#/ <br />Cash <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />Lw 1 <br />)i-7 <br />AfT1 <br />�ssL) <br />N*1 <br />S �I <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />