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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 <br />L.F1LL LVY •JJ3-/O`J/ 1 -UH INSYEG IIVNS CAYIKtb I T tAK rKUM UAIC I IbUti <br />JOB ADDRESS 2-(o <br />0-7 <br />�1In <br />CRY/ZIP lAA i TkJLJ <br />d <br />CROSS STREET <br />APN � � � V � <br />77- ��LL� � <br />PARCEL SIZE raj <br />I/�r <br />OWNER NAME \ <br />�• n�' �y,� <br />\ S � ocm <br />�/� 1/� � /� p^� <br />r/y1M1l Yl e 1 _ _ PHONE -41C5 <br />/ <br />'2546 ' 5 Z 1 <br />OWNER ADDRES�S(� <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE fl <br />CITY/STATEJZIP <br />N.,r��'�y� <br />❑ <br />�n <br />CONTRACTOR \ V <br />�i� S+ <br />/ 1�yy,J, y�� <br />►/`•�L��1 rte✓• 11 Il./• PHONE Y-� . <br />•n •� <br />/f���� <br />CONTRACTOR ADDRESS ✓..JNAawtA <br />h� <br />CRY/STATPJLP W�JY\� <br />(� <br />C" �� V <br />LICENSE C42 <br />LI -C-36 . OTHER <br />((((((""������ 111 <br />NUMBER � 1 \ EXPIRATION DATE 2u:3 <br />WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DES ED IAL TERNATNE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM J DESTRUCTION <br />INSTALLATION WILL SERVE: ✓ RESIDENCE COMMERCIAL OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 4NUMBER OF EMPLOYEES: <br />d <br />1 <br />SEPTIC TANK TYPE/MFG P ` CAPACITY 2—w�J/-y-�I� gal # OF COMPARTMENTS <br />❑ <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE fl <br />❑ <br />LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />l� <br />1 c Z F� 1 <br />LEACH LINES LEACHING CHAMBERS �Tr,n C 1 1 1 �hr.� #OF LINFS ✓ LENGTH OF LINES <br />DISTANCE TO NEAREST WELL ft EOUNOATION IlCi-►- (t PROPERTY LINE � fl <br />❑ <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ff <br />❑ <br />MOUNDED WIDTH ft LENGTH It DEPTH fl <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />SUMPS WIDTH It LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WGI I. ft FOUNDATION It PROPERTY LINE ft <br />❑ <br />DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br />DISTANCE TO NEAREST WELL ft� ft PROPERTY LINE ft <br />1 <br />lFOUNDATION <br />2Er <br />m <br />UI` <br />ft DEPTH ft <br />SEEPAGE PITS NUMBER 3 WIDTH���///��� <br />7? <br />ray <br />DISTANCE TO NEAREST WELL ft FOUNDATION PROPERTY LINE R <br />T ` <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATI�ONANND' THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />M/AIIMI IAA AR LJA110 All I/A A&^= Ain TI(`C D=ill IlOF/l Fl1P wCPFCTIl1MS - P/ wA SF rdl I /7001 057-7607 <br />• �/Cw��r���..�s- tV'L��tti/-��r/171P.9p <br />YMENT <br />'EIVED <br />RTMENT SEO LY 1 <br />Application Accepted By Date ZArea G Employee ID#K <br />i n <br />Final Inspection By - t /5Z Date SPECIAL PERMIT -Approved by <br />Character of SolI to Depth of 3 Ft: PIVSump So11 Char cter: <br />COMMENTS ry Q cf <br />, <br />PE SC Received hoc Amount ate Permit] Invoice # Permit ID# <br />Code INFO ash Remitted Service Request # <br />f <br />42-01 <br />4/14/18 <br />1 1 1022 <br />JIN COUNTY <br />OMENTAL <br />PARTMENT <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />