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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 GALL LUy 90J -/6y/ FOR INSPECTIONS LXPIREs/ 'I T EAR FKUM UAI t ISSUti <br />// <br />JOB ADDRESS E' d CITYIZIP v <br />CROSS STREET %/may /1% APN O -1 33�0D'7 PARCEL SIZE ?'-7F <br />A3 <br />�— <br />OWNER NAME Z/ a/ i 993 <br />OWNER ADDRESSn So S 1 e n }On OCA) G CITY/STATE/ZIP" �� k+- t' n1 ala lla <br />CONTRACTOR/C f �b/►,/� J [7�A—] % 1 C/ Xli PHONEn <br />CONTRACTOR ADDRESS I/ tic/ J //(/�� ��? CITY/STATE/ZIP C <br />G( /G�Ox(� A H <br />LICENSE RaC-42 11❑C-36 OTHER /!a NUMBER. EXPIRATION DATE <br />i <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # ;)0 R9 LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM 1.1 DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: J` NUMBER OF EMPLOYEES: <br />SEPTIC TANK TYPE/MFG /0,4 L-- CAPACITY �/1/ LTJ gal # OF COMPARTMENTS G� <br />❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION S )� ft PROPERTY LINE <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES ❑ LEACHING CHAMBERS <br /># OF LINES LENGTH OF LINES ��5� ft <br />DISTANCE TO NEAREST WELL f; -2S i ft FOUNDATION /(J % ft PROPERTY LINE '41 ft <br />❑ <br />FILTER BED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />MOUNDED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />SUMPS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />DISPOSAL PONDS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE ft <br />SEEPAGE PITS <br />NUMBER v <br />WIDTH /f <br />// <br />i I <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION 4/} Z <br />.;Z5 <br />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 />Character of Soil to Depth of 3 Ft: Pit/Sump Soil unaracter: <br />COMMENTS /y �J s ER r,Pr Well is 50u)Ik 10 be ('�Fsorder eevrnf/' ppoog3L*[ <br />-f{ sef6cis rd� met fi0 ►'jell1 a,T rmrf rLtIo be finelled. <br />PE <br />Code <br />SC <br />INFO <br />Received Ch k Amount at Permit/ Invoice # Permit ID# <br />By ash Remitted P t Service Re uest # <br />-WIU Ub&U',5qO <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />42-01 <br />4/14/18 <br />