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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-REFUNDABLE PERMIT GJALL (LUY) y5s-/bY[ FOR INSPECTIONS J CXPIKtS I T LAK t-KUM LJAI L IaauL <br />JOB ADDRESS - /�<� ��/�,C/! G-/7Ii5c Die CITYIZIP S/pr k&&j <br />CROSS STREET .4404 j h IJ;G k- 12X APN PARCEL SIZE O <br />OWNER NAME��/�• Q Q /%lx ���I _ PHONE <br />EOWNER ADDRESS O �v eljljP fif^ CITY/STATEIZIP G.K rJn qS cel a <br />CONTRACTOR �� � c✓� �^' fzL PHONE <br />CONTRACTOR ADDRESS�7Ls CITY/STATE/ZIP <br />LICENSE ❑ILC -42 ❑ I !C-36 OTHER <br />NUMBER fZ2k?V5-EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION <br />❑ PERC TEST # BUILDING PERMIT # <br />TYPE OF WORK: St, NEW INSTALLATION <br />II REPLACEMENT <br />Coordinates X <br />LAND USE APPLICATION #_ <br />REPAIR/ADDITION L ENGINEER DE <br />OUT -OF -SERVICE SEPTIC SYSTEM I J DESTRUCTION <br />Y <br />GN ED /ALTERNATIVE <br />INSTALLATION WILL SERVE: / D& RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: 7 NUMBER OF EMPLOYEES: <br />❑ <br />❑ <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG �,;2D0Ci <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL NONe. <br />SIZE TYPE OF PUMP <br />ft <br />CAPACITYU gal # OF COMPARTMENTS_ <br />CAPACITY -7 gal # OF COMPARTMENTS <br />FOUNDATION , ft PROPERTY LINE rO ! ft <br />/ <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />iQ <br />LEACH LINES <br />Ll LEACHING CHAMBERS <br />tp3 <br />S --?o <br />#OF LINES —"t LENGTH OF LINES �oo ft <br />f <br />DISTANCE TO NEAREST <br />WELL_AA:)Ne-- <br />ft <br />FOUNDATION 00 ft PROPERTY LINE S a ft <br />❑ <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 />❑ <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 />❑ <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 />❑ <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 WIDTH '/ap- <br />t7I ft DEPTH .257> ft <br />DISTANCE TO NEAREST <br />WELL K_&Ufe <br />ft <br />FOUNDATION ye) ft PROPERTY LINE S ft <br />I HEREBY CERTIFY THAT 1 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 />Application Accepted By Date 1- 1 Date C% / v �.� Area Employee ID#�7 <br />Final Inspection By Date 2 2 ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to DeptA of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS tJeVJ SFR :Ler Dryu py XA Vc/peS <br />loe,d(1 p f- tht' sept &mkr r;n<,LlP ; $5,f s V) tC. 1'n4 be twee; -7 rr)'e,X64 ; A-MF,vDtb RECd/rr Iro <br />0 <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check#/ <br />gash <br />Amount <br />Remitted <br />Date Permit/ <br />I I Service Request # <br />Invoice # <br />Permit ID# <br />tp3 <br />S --?o <br />f <br />(54g"(1 <br />42-01 <br />4//14/14/18 ll <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />