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ONSITE WASTEWATER TRE-ATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />BION -REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI <br />JOB ADDRESS , dw.� ,. 1 j A-vCITY/ZIP S[x;�r� 1 Ctrl <br />CROSS STREET �A �)�n► c� APN�C'� W ^ 22.,C t PARCEL SIZE <br />OWNER NAM_�i Sys ��1�� <br />OWNER ADDRESS *.I!+ <br />Tr� Sit 11+\tu�lr GLC f>•-�' l .,.4 • CITY/STATE/ZIP LA�h,T <br />CONTRACTOR APH/O�NE �y� <br />CONTRACTOR ADDRESS F� t�yf'//,A7�/ZIP <br />LICENSE ❑LIC -42 D❑C-36 OTHER NUMBER ��111 j ATE <br />WATER TABLE DEPTH: , ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />D PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: ❑ NEW INSTALLATION IJ REPAIR/ADDITION U ENGINEER DESIGNED /ALTERNATIVE <br />El <br />SEPTIC TANK <br />TYPE/MFG <br />Check#/ <br />Cash <br />CAPACITY <br />Date <br />gal # OF COMPARTMENTS <br />Farmit ID# <br />PRO ArImm <br />Ell <br />GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />_ <br />2 n `�°� <br />gal # OF COMPARTMENTS <br />WL A"AL I <br />DISTANCE TO NEAREST: <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />L7 <br />LIFT STATION <br />SIZE TYPE OF PUMP <br />® PKG TX PLANT <br />U <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />CA <br />LEACH LINES <br />D LEACHING CHAMBERS <br /># or- LINES <br />LENGTH OF LINES <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />(� <br />FILTER BED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />C.➢ <br />MOUNDED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />_ ft PROPERTY LINE <br />ft <br />0 <br />SUMPS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />f{ PROPERTY LINE <br />ft <br />E3 <br />DISPOSAL PONDS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />;{ <br />TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />CI <br />SEL�`H�UMiBEiR <br />WIDTH <br />ft DEPTH <br />ft <br />p <br />I E NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />1 HERE TIFY THAT I <br />HAVE PRE PAIRED ^THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND <br />REGULATIONS OF SAN JOAQUIN <br />COUNTY. <br />1w11j'&6jV1VIYI II \ V 1IYUL !Y I IVL IN[- I V!\ IIYJI-LkJI IVIYJ - r-LLHJG I.iFILL I4U'7z VU2"/yvi <br />TITLE ( Q� DATE I i <br />- / / — <br />RTMENT USE ON Y <br />Application Accepted By Date Area 1 <br />Final Inspection By Date D SPCA <br />Character of Soil to De th of 3 Ft: _ PiUSump Soil Character: <br />COMMENTS � -e--.,e 4`i) ��SS iP <br />J� '""ployee ID# S <br />PERMIT -Approved by <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />Check#/ <br />Cash <br />AmOUnt <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Farmit ID# <br />PRO ArImm <br />z74 <br />oIF <br />/ <br />_ <br />2 n `�°� <br />2 t� �56S <br />WL A"AL I <br />fn <br />lb <br />_ _ _„� <br />42-0'1 I O ' / ✓ UGVn%� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/141'18 <br />