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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-KEFUNDABLE VERMII <br />(:ALL (ZUY) yb3-/by/ FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI <br />JOB ADDRESS /� PITY/ZIP ,'L�jJf=` /'j <br />CROSS STREET Ji�hf9xJ T ICtX/J APN 0 �� 3 PARCEL SIZE " <br />OWNER NAME d♦ ;C1SS/CWS PHONE <br />OWNER ADDRESS <br />CITY/STATE/ZIP <br />CONTRACTOR 0 L //'1%Ae4" �dllCr PHONE S_Z ZZ? <br />CONTRACTOR ADDRESS%r��G?Ji�lLPti ?�il� L7•C CITY/STATE/ZIP <br />LICENSE ❑A-42 ❑ C-36 OTHER NUMBER{" EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # ,jg%Q,;2624 1.16 ? LAND USE APPLICATION # <br />TYPE OF WORK: d>4- NEW INSTALLATION I REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: 8X -RESIDENCE ❑ COMMERCIAL �❑ OTHER <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: r1`y NUMBER OF EMPLOYEES: <br />®i SEPTIC TANK <br />TYPE/MFG ��ez <br />CAPACITY AA00 <br />gal <br /># OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal <br /># OF COMPARTMENTS <br />SUMPS <br />DISTANCE TO NEAREST: WELL i- <br />ft FOUNDATION S <br />ft <br />PROPERTY LINE ;2 t ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />Cd— LEACH LINES <br />LEACHING CHAMBERS # OF LINES _ LENGTH OF LINES S ft <br />4- SEEPAGE PITS NUMBER <br />DISTANCE TO NEAREST <br />WELL�ft FOUNDATION -;70 ft PROPERTY LINE ft <br />ft LENGTH <br />DISTANCE TO NEAREST <br />FILTER BED <br />WIDTH <br />DEPTH ft <br />DISTANCE TO NEAREST <br />MOUNDED <br />WIDTH <br />Permit ID# <br />DISTANCE TO NEAREST <br />SUMPS <br />WIDTH <br />DISTANCE TO NEAREST <br />DISPOSAL PONDS <br />WIDTH <br />ft <br />DISTANCE TO NEAREST <br />4- SEEPAGE PITS NUMBER <br />DISTANCE TO NEAREST <br />WELL�ft FOUNDATION -;70 ft PROPERTY LINE ft <br />ft LENGTH <br />SC <br />INFO <br />Received <br />B <br />ft <br />DEPTH ft <br />WELL <br />ft <br />FOUNDATION <br />Permit ID# <br />ft PROPERTY LINE ft <br />ft LENGTH <br />ft <br />DEPTH ft <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />ft LENGTH <br />ft <br />DEPTH ft <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />ft LENGTH <br />ft <br />DEPTH ft <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />WIDTH <br />y� I <br />ft DEPTH �J S ft <br />WELL /T� f ft <br />FOUNDATION ?D <br />ft PROPERTY LINE 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 />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />- PLEASE CALL 209 953-7697 <br />SIGNED /J Cr - TITLE DATE A�/Yl�� <br />Application Accepted By ' <br />Final Inspection By <br />� <br />Character of Soil to Depth of 3 <br />COMMENTS S.:.D_ <br />ARTMENT USE ONLY u� �— <br />Date_ ZD`zArea / Employee ID#� <br />Date ❑ SPECIAL PERMIT -Approved by <br />Pit/Sump Soil Character: <br />orep-trp a fir✓ �„1rA <br />PE <br />Codel <br />SC <br />INFO <br />Received <br />B <br />Che <br />ash <br />Amount <br />Remitted <br />ate <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />4-4 <br />-V 1l �� <br />42-01 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />W.- <br />