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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 />IVUN-Mht ,UNUABLE PER/MIT (:ALL <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME ���/��Qe4,& f/ <br />OWNER ADDRESS <br />953-7697 FOR INSPECTIONS EXPIRES 1; YEAR FROM DATE ISSUE] <br />I S �lGi CITY/ZIP i,✓1�`L�1�J' �� �L �i'�p- <br />APIN Z %Li - D J' 0 <br />PARCEL SIZE <br />TATE/ZIP <br />CONTRACTOR PHONE <br />CONTRACTOR ADDRESS CITY/STATE/ZIP/yl�� <br />LICENSE ❑❑C-42 1111C-36 OTHER NUMBER EXPIRATION DATE_ j i' ! -2Z,,-- <br />PHON <br />WATER TABLE DEPTH: 120 ft GEOGRAPHICAL INFORMATION: <br />❑ PERC TEST # BUILDING PERMIT # <br />TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADC <br />Coordinates X Y <br />LAND USE APPLICATION # <br />IN ❑ ENGINEER DESIGNED /ALTERNATIVE <br />❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />Cash <br />DISTANCE TO NEAREST: <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ SAND <br />OIL SEPARATOR (ENCLOSED SYSTEM) <br />3a� <br />LEACH LINES <br />❑ LEACHING CHAMBERS <br /># OF LINES�% <br />J Do <br />LENGTH OF LINES /- �ppf1} <br />DISTANCE TO NEAREST <br />WELL �C7 ,1 <br />ft FOUNDATION p <br />ft PROPERTY LINE , L ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />_ ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAR T <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />XjSEEPAGE PITS <br />NUMBER I <br />WIDTH <br />/ <br />ft <br />DEPTH fl <br />DISTANCE TO NEAREST <br />WELL /U L2 �1 <br />ft FOUNDATION /11 } <br />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 />Final Inspection By ( %� L'L, Date Z. ZZ ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS ,�4, %�,re. ,�� f'T ,� box wil( <br />}O iID" I, nP �l.,,l,.lo /"�o ..IVI ,_.l L4— 1 14.— _71 ,n. , <br />r/OofG hla, <br />L <br />PP p b <br />PE <br />SC Received <br />Amount#Dae, <br />Permit/ <br />Code <br />INFO B <br />Cash <br />.RemittedService <br />Request # <br />Invoice # <br />Permit ID# <br />210 <br />//S; -o2 <br />3a� <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />