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PERMIT <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT EXPIRED <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABI PERMIT CALL 209 953-7697 FOR INSPECTIONS XPIRES -1 YEAR FROM DATE ISSUEI <br />JOB ADDRESS ✓✓ 1A, CITY//ZZ.IIPPf1� 3 <br />CROSS STREET �jlT`v APN '�' YIJU , / PARCEL SIZE I <br />OWNER NAME Ctf 'k' " �M ' t ' 0' 1 PHONE('YJ✓/+ <br />OWNER ADDRESS I ( /W "^ CITY/STATE/ZIP <br />Al <br />CONTRACTOR l�/��"�%��� ✓'j'''%/,. 4/�/�r t% �"� PHONEyV L v�14 y� lr'L,l�"t //� <br />CONTRACTOR ADDRESS � { V �S �! /V' V ' S ✓1 ! ` CITY/STATE/ZIP 6)` �`� `�✓ ' S �'-' "' <br />LICENSE ❑I1C-42 ❑1 -IC -36 OTHER v �I NUMBERgOL�J� EXPIRATION DATE �(Is t z', <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />❑ PERC TEST # <br />TYPE OF WORK: <br />BUILDING PERMIT # <br />NEW INSTALLATION I <br />R <br />LAND USE APPLICATION # <br />REPAIR/ADDITION ENGINEER DESIG ED /ALTERNATI <br />OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />Permit/ <br />INSTALLATION WILL SERVE: F-L;'N1lVA11IDENCE <br />I I COMMERCIAL <br />INFO B <br />CI OTHER <br />Date Inv <br />Re uest # R <br />Permit ID# <br />IT <br />NUMBER OF LIVING UNITS: ryPI Orn NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />\G <br />El <br />SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ <br />GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT <br />❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ <br />LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LIN[ <br />ft <br />❑ <br />FILTER BED <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />MOUNDED <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />SUMPS <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />DISPOSAL PONDS <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />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 />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS W <br />c <br />0 <br />v <br />�4jk <br />PE <br />SC Received <br />heck#I Amount <br />Permit/ <br />Code <br />INFO B <br />RemittedService <br />Date Inv <br />Re uest # R <br />Permit ID# <br />IT <br />\G <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />