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L, <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />IVUN-Mt1-UNUAt3Lt rLKMll <br />JOB ADDRESS <br />(:ALL (ZUY) 953-1UYf FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE <br />CROSS STREET _/��Qaa� j�. IC /� APN <br />OWNER NAME s ►` 0,4 lwe'^ 1A�,. i- 40, %a 1 <br />�f CITY/ZIP M!!G:4"'eCef FiIy+ ,y <br />v D �� PARCEL SIZE fl , <br />PHONE <br />OWNER ADDRESS CITY/STATE/ZIP/ p <br />CONTRACTOR)no <br />(�1r4, S �CGI� .L // S1 aC. PHONE ,��p �j <br />CONTRACTOR ADDRESS PO YJ/(LSU CITY/STATE/ZIP --' G A 14,f /5­2glj) <br />LICENSE 11uC-42 ❑! 1C-36 OTHER NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION C ENGINEER DESIGNED <br />I I REPLACEMENT I I OUT -0F -SERVICE SEPTIC SYSTEM C DESTRUCTION <br />INSTALLATION WILL SERVE: ESIDENCE 11 COMMERCIAL El OTHER <br />NUMBER OF LIVING UNITS: ` NUMBER OF BEDROOMS: 41 NUMBER OF EMPLOYEES: <br />TERNATIVE <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY gal # OF COMPARTMENTS <br />Permit/ <br />Service Request # <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />1_1 LEACHING CHAMBERS <br /># OF LINES LENGTH OF LINES ft <br />L4 <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />0 FILTER BED <br />WIDTH ft LENGTH <br />ft DEPTH << ft <br />DISTANCE TO NEAREST WELL /1)nI <br />ft FOUNDATION (� I ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION 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 <br />HOUR ADV NCE NOTICE REQUIRED <br />FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br />SIGNED <br />1 _ <br />TITLE �tCa-y > DATE.7) o <br />E ARTMEN U EONL Q� <br />Application Accepted By -� Date Area ' l i Employee ID#� <br />Final Inspection By Date L1 jNL'1q,0_Z1j�-SPECIAL PERMIT -Approved by <br />Character of Soil to Dep h of 3 Vt-tV Pit/Sump Soil Character: <br />COMMENTS �\C�P�. b1���sc��= '� = 2In�j <br />�QDPR�c> (,00l.A;�`�t�"CC� nom• �N Fes. L. - <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By. <br />Check#/ <br />Cash <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />( <br />-j <br />ZC'100V <br />L4 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />