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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDAB L 7E PERMIT r� GALL (ZU9) 953-/69/ FOR INSPECTIONS E=XPIRES i YEAR FROM LATE ISSUEI JOB ADDRESS, IfG"�- �/� � CJ r c0 47 CITY/ZIPt�� CROSS STREET (..,moi f 1�^ APN 0 sa 1 a 000 PARCEL SIZE k- L OWNER NAME EJC: 1 = n/ 7Q / i ! 1i/JPHONE OWNER ADDRESS S /7 t 1'�. �) CITY/STATE/ZIP CONTRACTOR( /�1C PHONE CONTRACTOR ADDRESS &K CONTRACTOR !O �', CITY/STATE/ZIP LICENSE LILIC-42 ❑I IC -36 OTHER NUMBEREXPIRATION DATE WATER TABLE DEPTH: IPSS fk� h 10 ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION IJ ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM i7 DESTRUCTION INSTALLATION WILL SERVE: ESIDENCE I I COMMERCIAL LI OTHER NUMBER OF LIVING UNITS: II NUMBER OF BEDROOMS: 0 NUMBER OF EMPLOYEES: 41-_S*`EPTIC TANK TYPE/MFG ReceivedChe CAPACITY t ce QJ gal # OF COMPARTMENTS Amount ❑ GREASE TRAP TYPE/MFG Permit ID# CAPACITY gal # OF COMPARTMENTS INFO B DISTANCE TO NEAREST: WELL ft ! FOUNDATION ft PROPERTY LINE 1 ft L3LIFT STATION SIZE TYPE OF PUMP L3PKG TX PLANT ' ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) IIT LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES Jo6I ft DISTANCE TO NEAREST WELL _ t1 fi ft + FOUNDATION a Sr ft PROPERTY LINE Id ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE_ PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT .,.... ...... I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. Final Inspection By. Date ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: n Pit ump Soil Character: --// COMMENTS .SFfZ T;e-r Na Wel S w1��'►vn s'e'p c 0IeGS _�C'r eyuyl' / fr-/o7U< PE Sc ReceivedChe / Amount Date Permit/ Invoice # Permit ID# Code INFO B Cash Remitted ervice Re uest # gall - ?'-7 WIT 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/'14/1H '