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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1888 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />953-7697 FOR <br />1 YEAR <br />JDB ADOFIESS S / yy ffxLp?, TC,}t Lw CTrY22 <br />1P 0700AAA4 �JZ ) <br />CROSS STREET 194 #4M.B RA /7pF APN 'T PARCEL SIZE <br />OWNER NAM PHONE <br />PHONE <br />OWNER ADDRESS �(r/C CITY/STAT/EiLP <br />CDNTRACTDRJJ LO�1/57 µG'JTpN 3 S SG/��1/C <br />PHONE I �II() x+2.2 �J�p,�p <br />CONTRACTOR ADDRESS 557 (770AZTSON Z,4EEK OA sw yAW CRY/STATE/ZIP JALR�fA�EJ47 /�� % `� 2 <br />LICENSE ❑ � C-42 D C-36 OTHER NUMBER "y3�- EXPiRAT10N DATE 6 (e 1207 0 <br />WATER TABLE DEPTH:_ ft GEOGRAPHICAL INFORMATION: Coordinates X V <br />0 PERC TESTBUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: /NEW INSTALLATION REPAIR/ADDTTION ENGINEER DESIGN /AL qL TIV <br />t1 REPLACEMENT Our -OF -SERVICE SEPTIC SYSTEM DESTRUCTIO <br />INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL//// UOTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_%(y_�I",pJ�UMBER OF EMPLOYEES: <br />YJ SEPTIC TANK <br />TYPEIMFG CAPACITY /%Pi u gal # OF COMPARTMENTS <br />❑ GREASETRAP <br />TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />�w�TR4-rdK <br />LEACH LINES <br />LEACHINGCHAMBERS #OF LINES z LENGTH OF LINES y�� ft <br />DISTANCE TO NEAREST WELL /00 R FOUNDATION /S I ft PROPERTY LINE �� ft <br />❑ FILTER BED <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH It LENGTH it DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH it DEPTH It <br />y/ <br />DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br />u SEEPAGE PITS <br />NUMBER '�z WIDTH y.$ It ft DEPTH -2G I ft <br />DISTANCE TO NEAREST WELL /.Sb' ft FOUNDATION �ft PROPERTYLINE •S' 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 />��� - _�-a_�.v»avr.v-euti�� irn-f7rvnrcn77-171(4L'6�1�Ia1F73E1ai�1'�(rk <br />tNAHT M&iV USE Y <br />Application Accept Date 2' Area I� Employee ID#-/ <br />Final inspection By ,, Date ;; �d L,1 ; / - r iI,/ it SPECIAL PERMIT- Approved by <br />41 <br />4//1414/18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />I] <br />n <br />