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A 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 JOBADDRESS :3Jx A 2/o �^ CROSS STREET C kCakq-z- 953-7697 FOR INSPECTIONS CITY/ZIP .�( APN I z 0 bU0" f t,XPIRES 1 YEAR FRAM DATE ISSUEI PARCEL SIZE 2, 1 LICENSE ❑❑C42 ❑❑C-36 OTHER NUMBER EXPIRATION WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # OWNER NAME 1- LAND USE APPLICATION # PHONE ❑ NEW INSTALLATION ❑ / OWNER ADDRESS �r, �� CITY/STATE/ZIP A / 1t1/I�Z J 1kno ><f DESTRUCTION JIG{ -`/7�►�� ❑ COMMERCIAL CONTRACTOR J 12 PHONE NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 7 CITYISTATEiZIPS /��.qC1 /t7 /� Y/�--Z ` r&(A (//^f TYPE/MFG CONTRACTOR ADDRESS J / gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG LICENSE ❑❑C42 ❑❑C-36 OTHER NUMBER EXPIRATION WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE FOUNDATION ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ><f DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER Permit ID# NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: DISTANCE TO NEAREST ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS Received # OF LINES LENGTH OF LINES ft Permit/ DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH Invoice # Permit ID# 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 (t DEPTH ft DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, QAM InernnN rnnMTY Application Accepted B Final Inspection By Character of Soil to pt/h c COMMENTS C-ftk 4-O s. r?lzz wdz I i O PARTMENT USE ONLY V A JJ-0p U,q, Dale—!/2.4" � Z'7?.�A�rea ( f Employee ID# Date -( if ZIZ'02 .IJ SPECIAL PERMIT -Approved by Pit/Sump Soil Character: 'j v� � SP02rc>< � ►� O,4— 11 l0 i✓1G^-e- 4-r U w 5 i,- -? ,rte . 6 C" 6c: 4v0- S�-f PE SC Received heck#/ Amount Permit/ Code INFO By Cash Remitted__Service Date R quest # Invoice # Permit ID# L� /l ��k' r 0. I�n16V Ale L+ -j� 7- ?/ � 6% / ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 414/18 00 lO ®g l 0��la�C� C �J