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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E HAZELTON AVENUE - STOCKTON CA 95205 - (209) 4683420 <br />NUN -REFUNDABLE PERMIT 11 (;ALL (2U.9) 953-7597 FOR INSPECTIONS nn EXPIRES 1 YEAR FROM DATE ISSUEI <br />JOB ADDRESS 'k) QJ LX�NE fpp"T>- 'r CrrY%LIP TI?�L 8736 AV - <br />OWNER <br />STREET 1` 1'_7 S w� N APN ��T �— Dd PARCEL SIZE p..�G •9 (0 rQ . <br />OWNER NAME �yq C f 0 -TD-r,� �' �� � �7 PHONE iD I 0 — O •�V Z-{' <br />OWNER ADDRESS <br />I �S `//��,,���`� CSI.-Ir� �� r S w �� CrrY/STATE/ZIP I'� I P -i !V C^ 1) J 3 to (P <br />CONTRACTOR LAS C O A-V-- PHONE_ 3(PC, —C)--�-13— <br />CONTRACTOR <br />13CONTRACTOR ADDRESS —T C' --I W C ST- CRY/STATE/ZIP <br />LICENSE 0I:IC-42 11I.iC-36 OTHER CBCT NUMBER Zl S( EXPIRATION DATE`�-Z- <br />J <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />PERC TEST #BUILDING <br />PERMIT # <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />❑ NEW INSTALLATION <br />D. <br />REPAIR/ADDITION <br />❑ ENGINEER DESIGNEE)/ALTERNATIVE <br />,.., REPLACEMENT <br />CI <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />Q DESTRUCTION <br />INSTALLATION <br />WILL <br />SERVE: ❑ RESIDENCE <br />❑ COMMERCIAL <br />❑ OTHER <br />NUMBER OF LIVING UNITS: <br />NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ <br />SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ <br />GREASETRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS_ <br />DISTANCE TO NEAREST: <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE 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 />I:! LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINESPA <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE �n of <br />El <br />FILTER BED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ��(1(® �P <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />MOUNDED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH �Itff <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE It <br />ft <br />El <br />sumps <br />WIDTH <br />ft LENGTH <br />ft <br />��� <br />DEPTH " 610A <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE�c�, Rn <br />El <br />DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft <br />�, M <br />DEPTH HDA <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE ftp' <br />❑ <br />SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />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 />MINIMUM 48 HQUa ADVANC OTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209)953-7697 <br />SIGNED TITLE DATE I - `-i -Z-Z <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS <br />Pit/Sump Soil Character: <br />PE SC Received Amount Date Permit/Invoice # Permit ID# <br />Code INFO Cash Remitted Service Request # <br />Z CZ Z �Y <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />Vr <br />