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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 />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE[ <br />JOB ADDRESS 42-L"- .4,e 5 v Ni]%j (,�� K CITY/ZIP S' % o C-&7ZEN gS L o r <br />CROSS STREET All- - y ' ` ' / APIN � I L1yLl 0 � PARCEL SIZE � a3 <br />OWNER NAME �A -7 A, c-k-�`' E' lit r U S�� PHONE Y-00 3 Y <br />OWNERADDRESS 37 -ZZ CITY/STATE/ZIP <br />CONTRACTOR PHONE <br />CONTRACTOR ADDRESS CITY/STATE/ZIP <br />LICENSE DEC -42 ❑nC-36 OTHER NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION <br />❑ PERC TEST # BUILDING PERMIT # <br />TYPE OF WORK: 1 NEW INSTALLATION J REPAIR/ADI <br />Coordinates X Y <br />LAND USE APPLICATION #_ <br />IN I I ENGINEER DESK <br />"I REPLACEMENT C! OUT -OF -SERVICE SEPTIC SYSTEM �7 DESTRUCTION TG, Il <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG <br />❑ GREASE TRAP TYPE/MFG <br />CAPACITY <br />CAPACITY <br />DISTANCE TO NEAREST: WELL ft FOUNDATION <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT <br />TERNATIVE <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />PE SC Received Check#/ <br />Code INFO By sh <br />Amount Dat Permit/ <br />Remitted Service Re est # <br />Invoice # Permit ID# <br />9),)) 0-75' <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />PE SC Received Check#/ <br />Code INFO By sh <br />Amount Dat Permit/ <br />Remitted Service Re est # <br />Invoice # Permit ID# <br />9),)) 0-75' <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />