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PRMFT <br />EXPIRED <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-KEFUNDABLE PERMIT J� [:ALL (LU9) ybJ-/bY1 FOR INSPECTIONS tXPIRES I YEAR FROM UATEISSUE[ <br />JOB ADDRESS 3 37 pS. A-%,,jQ;-� CITY/ZIP [J� CM • S�04- <br />CROSS STREET C.-.�1`� �T� APN ZICq 1f'� T PARRCELL SIZE ( 1& <br />OWNER NAME �+ lC'1�`1�S '�T'J +nAZ 6 PHONErr 'Zd-1 / C"67�� _�' ` �� <br />OWNER ADDRESS �`` Z LJ, I ( ` "ST - C*$r -73 CITY/STATE/ZIP 'rz4%_ CLA • <br />CONTRACTOR A� TEL PHONE <br />CONTRACTOR ADDRESS CITY/STATE/ZIP <br />LICENSE ❑❑C-42 1111C-36 OTHER NUMBER EXPIRATION <br />WATER TABLE DEPTH: <br />SC <br />ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # <br />Amount <br />BUILDING PERMIT # <br />Permit/ <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION <br />1 <br />R AIR/ADDITION <br />D ENGINEER DESIGNED /ALTERNATIVE <br />J REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM I DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE <br />❑ COMMERCIAL <br />OTHER <br />NUMBER OF LIVING UNITS: <br />NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: <br />WELLI <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />L LEACH LINES <br />❑ LEACHING CHAMBERS <br /># of LINES <br />LENGTH OF LINES 6� ft <br />/ <br />DISTANCE TO NEAREST <br />WELL <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft DEPTH X( V ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />d=SaS <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />2 02 <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE M ft <br />DWOSAL PONDS <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />W X <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />Sk4AGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />1 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 />DEPAR TMENt USE ONLY <br />Application Accepted By Date" ZJ Area Employee ID# <br />Final Inspection By Date ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS 117L��/il/C� <br />PE <br />SC <br />Received <br />Check <br />Amount <br />Date <br />Permit/ <br />Invoice # Permit ID# <br />Code <br />INFO <br />as <br />Rem'tted <br />Service Request # <br />u� <br />PER I <br />Ile <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114/18 <br />T <br />a <br />M <br />J+ <br />v <br />v <br />z <br />m <br />