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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 PERMIT L;AILL (LU.9) 40J -10Y/ FOR INSPECTIONS CXPIKES "I 1'EAK FKOM UAIE ISSUtl <br />JOB ADDRESS�Z,� � �G � CITY/ZIP 4,Ls (` /G,A- <br />p <br />CROSS STREET _� `%%(} j �, J APN t��� �PARCEL SIZE ��y <br />OWNER NAME 1' -li'I hn /2,oc-, �G� Le �'� (SI Co L - P PHONE <br />OWNER ADDRESS �! JZ S Lay?p fir -p p CITY/STATE/ZIP S5 Ct• 10:1 ��3�� n <br />CONTRACTOR/� 1 �\ el S-ec PHONE A� 4 <br />CONTRACTOR ADDRESS PL2 An �r6, (-I� CITY/STATE/ZIP <br />LICENSE ❑11C-42 DIZ-36 OTHER NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: <br />❑ PERC TEST # BUILDING PERMIT #7� <br />TYPE OF WORK: LI NEW INSTALLATION REPAIR/ADC <br />Coordinates X <br />LAND USE APPLICATION #. <br />1N C ENGINEER DI <br />Y <br />GNED/ALTERNATIVE <br />REPLACEMENT 1 i OUT -OF -SERVICE SEPTIC SYSTEM )( DESTRUCTION 14{9 k <br />INSTALLATION WILL SERVE: L? KESIDENCE ❑ COMMERCIALrr�� FIV, 11 OTHER <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: eC L�-.1T 1 '` �Jr NUMBER OF EMPLOYEES: <br />7 <br />0' SEPTIC TANK <br />❑ GREASE TRAP <br />❑ LIFT STATION <br />TYPE/MFG P� L <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE OF PUMP <br />ft <br />CAPACITYrJb gal # OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />FOUNDATION ft PROPERTY LINE ft <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0100OLEACH LINES <br />LI LEACHING CHAMBERS <br />Permit/Invoice <br />Service Request # <br /># OF LINES cj � LENGTH OF LINES f ft <br />Permit ID# <br />DISTANCE TO NEAREST <br />WELL L a�JL <br />ft <br />FOUNDATION 16' ft PROPERTY LINE b��l ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS <br />NUMBER I- WIDTH <br />'j <br />tW <br />� <br />II DEPTH a - <br />a ft ft <br />DISTANCE TO NEAREST <br />WELL I S'n=71 <br />FOUNDATION to ` ft PROPERTY LINE )I 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 />SIGNED <br />vn 11v.J1rc%,I1w1r17 - 14v; <br />TITLE {�CrL i DATE <br />ENT <br />DEPARTMENT,us& ONLY <br />Application Accepted By L Date 3-2 Area Employee ID# <br />Final Inspection By Date `� %2'a 1—-— ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS-pl,,de,4�1n���e , TPr J-1. Fx1�Firti �1n�S h �� cbc-nF�Gr�e <br />J�ICiv CISy �JG.Ut'_ 6P,N 130,0iq <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />Cl <br />Cash <br />Amount <br />Remitted <br />Dat <br />Permit/Invoice <br />Service Request # <br /># <br />Permit ID# <br />alo <br />ils <br />i <br />43GI <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />