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- r r 1 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED LEACHING CHAMBERS JOB ADDRESS I CITY/ZIP v CROSS STREET E; M PARCEL SIZE - C fi Irl P<1 APN 0&7 — ! 15D —IV? ` m Permit ID# t �� OWNER NAME 1 PHHrONNE Fn OWNER ADDRESS P CITY/STATE/ZIP ft PROPERTY LINE ft WIDTH CONTRACTOR PHONE ft CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑I .C-42 ❑ 'C-36 OTHER NUMBER EXPIRATION DATE ft WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ft ❑ PERC TEST # BUILDING PERMIT # F -4P-- uf% /7'�SL LAND USE APPLICATION # ft TYPE OF WORK: V NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE DEPTH ft REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION DISTANCE TO NEAREST INSTALLATION WILL SERVE: V RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: 7. 91 SEPTIC TANK TYPE/MFG l �� (-e. �� CAPACITY l gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) U' LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES 55 ft Amount RemittedService Date Permit/ Request # ~^ Permit ID# Z/ � DISTANCE TO NEAREST WELL ft ft FOUNDATION ft PROPERTY LINE 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 – /- SEEPAGE PITS DISTANCE TO NEAREST WELL FOUNDATION I ft PROPERTY LINE 2-45 ft /ft WIDTH —a6 I NUMBER —3 DISTANCE TO NEAREST WELL j G ft ft FOUNDATION � DEPTH ft PROPERTY LINE ft 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. 1�111� IV/I/ TV IIV \ AV AI�VL IAV IIV \L VII\LV I VI\ 11•JrLV / IV/r\7 - rLL/'7JL V/`1LL LVJ JJJ-/ U.7/ SIGNED TITLE n LS � V Q .� DATE �� ^ c, DEPARTMENT USE ONLY p AA Application Accepted By Date S 2 Area / Employee ID# iraraCv Final Inspection ByDate Z ZZ L1SPECIAL PERMIT -Approved by Character of Soil to Depth A 3 Ft: Pit/Sump Soil Character: COMMENTS 1, o� �� 1 tL(, I PE Code SC INFO Received Check#/ Cash Amount RemittedService Date Permit/ Request # Invoice # Permit ID# Z/ 117 z512 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18