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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-KEFUNDABLE PERMIT (:ALL (ZUy) 90J -/by/ FOR INSPECTIONS�� tXPIRES 'I YEAR FROM UATE ISSUEJOB ADDRESS _�L/61'0 �C KJia lh 4,,j 611CITY/ZIP S ¢x <br />I <br />CROSS STREET �'> > I d re APN 000:5-5900 7 PARCEL SIZE i <br />OWNER NAME /I_✓µJeS� ,� jliv/I/ PHONE 3kOU <br />OWNER ADDRESS / CITY/STATE/ZIP <br />CONTRACTORCom.,/xnL J7�/�ru / XiL PHONE 3G�1-Sozi7J <br />CONTRACTOR ADDRESS %y� K/Cc�w � � �i� CITY/STATE/ZIP 3416/_, <br />' <br />LICENSE DAC -42 ❑0C-36 OTHER <br />NUMBER 1S`JG�%� EXPIRATION DATE e7 'Z� <br />WATER TABLE DEPTH: 60-70 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # G? O O q 7 y o9 LAND USE APPLICATION # <br />TYPE OF WORK: I�, NEW INSTALLATION Ll REPAIR/ADDITION EI ENGINEER DESIGNED /ALTERNATIVE <br />❑ REPLACEMENT iJ OUT -OF -SERVICE SEPTIC SYSTEM I -i DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL yM,)fe than ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: I SOD I t'� NUMBER OF EMPLOYEES: <br />❑ <br />❑ <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG�f f� <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL 150 ft <br />SIZE TYPE OF PUMP <br />CAPACITY gal # OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />FOUNDATION %O ft PROPERTY LINE /IS , ft <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />R <br />LEACH LINES <br />Ll LEACHING CHAMBERS <br /># OF LINES _ LENGTH OF LINES SS ft <br />Permit ID# <br />Code <br />DISTANCE TO NEAREST <br />WELL /?S ft <br />FOUNDATION VO ft PROPERTY LINE 2Qi ft <br />❑ <br />FILTER BED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />lid l <br />�» <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ <br />MOUNDED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION ft PROPERTY LINE ft <br />L° <br />SUMPS <br />WIDTH _ <br />ft LENGTH <br />I ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION ft PROPERTY LINE 26 ft <br />❑ <br />DISPOSAL PONDS <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ <br />SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION 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 />Application Accepted By ��� <br />Final Inspection By <br />Character of Soil to Dept of 3 Ft: <br />COMMENTS fion repe,+r TIer . <br />e��menf f'or 121±fi CGin i be <br />C)CCe!S C-Ireci, <br />TITLE L!yj�o.� DATE <br />/ a G V /\ L I <br />'2j Area Vqq Employee ID# If0)1 <br />'-- ❑ SPECIAL PERMIT -Approved by <br />Pit/Sump Soil Character: <br />PE <br />SC <br />Receive <br />Check#/ <br />Amount <br />Date <br />Permit/ <br />Invoice # <br />Permit ID# <br />Code <br />INFO <br />Cash <br />Remitted <br />-V0� <br />Service Request # <br />lid l <br />�» <br />SOLI <br />33 z <br />-�� <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />T <br />