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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 />IYUN-Rtr'UIVUAt$Lt rt:Kml I <br />GALL LUY y5J-/6y/ FOR INSPECTIONS <br />EXPIRES 1 YEAR FROM DATE ISSUEI <br />JOBADDRESS �fU©O� <br />DISTANCE TO NEAREST <br />./ n <br />SII__r GIIY �oZ� CITY/ZIP 9z/'U// <br />9,5 -?k s <br />CROSS STREET <br />pYI <br />C <br />V APN O)LI✓ C)b Q l C2 <br />j <br />PARCEL SIZE S. q / <br />n/� <br />OWNER NAME .�RAt4�IA <br />��1Ij4U` <br />L�/✓,/. &iG�a7 VJ ill �l Gjrz, I j LL <br />PHONE;!,o 3 <br />OWNER ADDRESS/y <br />/ O()v 2! <br />�J— {� <br />,4-S /� 114; y� I -90 0 QF X 9 V CITY/STATE/ZIIP <br />���1„l ��s <br />CONTRACTOR (SHF-!wEk <br />DISTANCE TO NEAREST <br />-a <br />,, <br />� OA4�7 Swz- -1wZ-7 PHONE-2—-{-�{/2 <br />ft FOUNDATION <br />CONTRACTOR ADDRESS <br />d • �V��� CITY/STATE/ZIP K L C <br />LICENSE ❑LiC-42 <br />❑❑C-36 <br />OTHER )2eJ157 NUMBER C C EXPIRATION DATE <br />O <br />W ER TABLE DEPTH: / ✓ ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION I I ENGINEER DESIGNED /ALTERNATIVE <br />❑ REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM I I DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES r- LEACHING CHAMBERS # OF LINES LENGTH OF LINES <br />❑ FILTER BED <br />❑ MOUNDED <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WELL ft <br />ft LENGTH <br />WELL ft <br />ft LENGTH <br />FOUNDATION ft PROPERTY LINE <br />ft DEPTH <br />FOUNDATION <br />WELL ft FOUNDATION <br />ft <br />ft DEPTF <br />ft <br />PROPERTY LINE <br />PROPERTY LINE <br />❑ SUMPS WIDTH <br />ft LENGTH <br />Chec Amount <br />sh Remitted <br />ft DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />❑ SEEPAGE PITS NUMBER <br />WIDTH <br />ft DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />DEPARTMENT)USE ONLY <br />Application Accepted y 11 Date L pp Area S G Employee ID# <br />Final Inspection Byrz <br />Date r1Z -F2 SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3W. Pit/Sump Soil Character: <br />COMMENTS hJ.5-0 16636 Gra 1000 51644_ Rav1e 1aa <br />- to17” Pry _T(I-Sr >�c �r✓� - <br />PE <br />Code <br />SC Received <br />INFO B <br />Chec Amount <br />sh Remitted <br />Date Permit/ Invoice # <br />Service Request # <br />Permit ID# <br />�Iaaa <br />sa3 <br />4)$"a <br />! Z 5 1 (Al <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />