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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 CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS ��rdJ3 c J �J of A0 (CITY/ZIP J �'-G y / cy� <br />CROSS STREET _A'11-/� AP i I (/�Z r { �4 PARCEL SIZE - <br />OWNER NAME�LIU�pVI C�J/'s�V/�r 0 PHONE C <br />OWNER ADDRESS 2162ASJ CITY/STATE/ZIP <br />I <br />CONTRACTOR I�� �� : [/ tf}+? Gi PHONE l I+,sz SAL S - <br />CONTRACTOR ADDRESS I S J CITY/STATE/ZIP <br />LICENSE 00C-42 ❑CIC -36 OTHER -A. NUMBER —EXPIRATION DATE <br />WATER TABLE DEPTH: less t6 N lO ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION U REPAIRIADDITION I.1 ENGINEER DESIGNED /ALTERNATIVE <br />Fj REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM Ll DESTRUCTION <br />INSTALLATION WILL SERVE: / RESIDENCE ❑ COMMERCIAL CI OTHER <br />NUMBER OF LIVING UNITS: ( NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />W SEPTIC TANK <br />TYPE/MFG Ptt�� <br />CAPACITY gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: <br />WELLft <br />FOUNDATION Jr ft PROPERTY LINE I212 t— ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />U LEACHING CHAMBERS <br />#OF LINES �- LENGTH OF LINES 1 ft <br />DISTANCE TO NEAREST <br />WELL ft ft <br />FOUNDATION_ ft PROPERTY LINE <br />C FILTER BED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION ft PROPERTY LINE ft <br />C! SEEPAGE_ PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft <br />FOUNDATION ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT <br />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 />u C I- H I[ / IY/ C IV I LI J C V IV L 7 <br />Application Accepted By. Date 11 S o Area s 9 Employee ID#4(--7 <br />Final Inspection By Date O SPECIAL PERMIT-ApprOded by <br />Character of Soil to Depth of 3 Ft: it/Sump Soil Character: <br />COMMENTS SFK ln .SeIL4Li 07tcr_5 p e,- Gvyn , teppraS' <br />PE SC Received Chec / Amount Date Permit/ Invoice # Permit ID# <br />Code INFO By sh Remitted Service Re uest # <br />9d11 117Jr <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />v <br />y <br />b <br />En <br />