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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 <br />JOB ADDRESS <br />CROSS STREET 1 5;�<It1 <br />(:ALL (LU`J) `900 -/Dy/ F -UK INS1't(:11UIVS [ZAVIKLO I i r -AK rKUIVI LJAI r 1000r -I <br />CITY/ZIP A_1Or'4z7g. (✓T— <br />APN O $6 Qy S 1 d PARCEL SIZE <br />OWNER NAME J CU 1 '�_ ( "MV) d�-1 PHONE J� (I^J+ <br />OWNER ADDRESS io3a/l11s <br />0 re hu e- CITY/STATE/ZIP �j l%xCl7�n �I s -d10 <br />CONTRACTOR r Vq rl t PHONE -25 <br />CONTRACTOR ADDRESS 7 "�"` CITY/STATE/ZIP <br />LICENSE ❑IdC-42 ❑❑C-36 OTHER NUMBER TS7oS EXPIRATION DATE <br />WATER TABLE DEPTH: - Xy ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: 0 NEW INSTALLATION REPAIR/ADDITION I <br />D ENGINEER DESIGNED /ALTERNATIVE <br />0 REPLACEMENT iJ OUT -OF -SERVICE SEPTIC SYSTEM I I DESTRUCTION <br />INSTALLATION WILL SERVE: 2 RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG n CAPACITY 16400 gal # OF COMPARTMENTS <br />❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />DEPARTMENT USE ONLY <br />Application Accepted B L� Date 3 � -' Area Employee ID# f {C� i� � �7 <br />Final Inspection By Date_'? �Z� �� ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil CharacteI : <br />COMMENTS L,A/sf-jhrI1� 022 Ll �rrvll✓l�� filer <br />LEACH LINES Cl LEACHING CHAMBERS(r <br /># OF LINES_ LENGTH OF LINES <br />55 ft <br />Check#/ <br />DISTANCE TO NEAREST WELL I'aofl C <br />ft FOUNDATION �® ft PROPERTY LINE <br />' ft <br />❑ <br />FILTER BED WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />Remitted <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ <br />MOUNDED WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />-1 <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ <br />SUMPS WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ <br />DISPOSAL PONDS WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />`J <br />}�J <br />DISTANCE TO NEAREST WELL <br />SEEPAGE PITS NUMBER I' WIDTH <br />ft FOUNDATION ft PROPERTY LINE <br />361, ft DEPTH ")`Jr � <br />ft <br />ft <br />/// \\\ <br />r- <br />DISTANCE TO NEAREST WELL PLQ)C <br />ft 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 <br />OF SAN JOAQUIN COUNTY. <br />MINIMUM48 HOUR ADVAblQCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 <br />953-76697 <br />SIGNED <br />TITLE D'7 DATE <br />7^ / --02 <br />DEPARTMENT USE ONLY <br />Application Accepted B L� Date 3 � -' Area Employee ID# f {C� i� � �7 <br />Final Inspection By Date_'? �Z� �� ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil CharacteI : <br />COMMENTS L,A/sf-jhrI1� 022 Ll �rrvll✓l�� filer <br />42-01 <br />4/14/18 <br />Invoice # I Permit ID# <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />PE <br />SC <br />Received <br />Check#/ <br />Amount <br />at <br />rermitl <br />Code <br />INFO <br />C sh <br />Remitted <br />Se ice Re u t # <br />-la 10 <br />1►S <br />AV <br />+3 -D -O <br />-1 <br />42-01 <br />4/14/18 <br />Invoice # I Permit ID# <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />