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t N <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />JOB ADDRESS <br />ZU9 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE <br />CITY/ZIP? <br />CROSS STREET _S <br />rl te(.✓J <br />APN L� <br />Z�� 2- PARCEL SIZE ) 7 2- I <br />OWNER NAME <br />Com•A (v� <br />� � O <br />PHONE t <br />OWNER ADDRESS <br />ft PROPERTY LINE ft <br />^' • <br />CITY/STATE/ZZIP/� % <br />CONTRACTOR �1�J/f <br />/)� ,J)�rJl <br />` 4 �Q-v C^ <br />PHONE <br />CONTRACTOR ADDRESS -/ <br />�P�N� ^�W v� <br />CITY/STATE/ZIP <br />LICENSE 111.!C-42 <br />Eli ,C-36 OTHER <br />/ ' NUMBER ( J C!, 3 <br />EXPIRATION DATE !�/ 2 o Z 3 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: ❑ NEW INSTALLATION C REPAIR/ADDITION I_ ENGINEER DESIGNED /ALTERNATIVE <br />w, REPLACEMENT150��S r i_i OUT -OF -SERVICE SEPTIC SYSTEM ('P DESTRUCTION '//� ""k - <br />INSTALLATION WILL SERVE: Al RESIDENCE ❑ COMMERCIAL ft'i yrs '❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: Ung' �Q NUMBER OF EMPLOYEES: <br />rM i / — z 9L d \�vvq 7 <br />19 <br />acr i w i Mrvn i YrtnV1rc1 {/ P L UAFAGI I Y gal TF UI- LUMHAR I MEN 16 <br />❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL /---,!J ft FOUNDATION ft PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />I_! LEACHING CHAMBERS <br /># OF LINES <br />Chec <br />Cash <br />LENGTH OF LINES ft <br />Date <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />Permit ID# <br />ft PROPERTY LINE ft <br />© FILTER BED <br />WIDTH E 0 ft LENGTH <br />? (�, f <br />ft <br />DEPTH ,9" t ,; /S/ --f- ft <br />Z.�L <br />DISTANCE TO NEAREST WELL `0 S0 <br />ft FOUNDATION 0 <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <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 />SIGNED <br />`i— <br />iu^ DATE/ ZZ% ZU Z -Z— <br />D E P A R T M E N T tU S <br />DEPARTMENTrUS ONLY q Vco Ttrq�4HrftS <br />Application Accepted By � L�� Date 61-1-112Area / Employee i' <br />Final Inspection By ,a /b�� � Date 2,e-/22 ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS 0r -7d4, elm✓,9,W it 2pplc, � �� u ole SX5Tr°�,-� ��,3 I»c, �1�►eS v <br />be ca�c>>7l%neP,� �vi�b�F' � ppb �, ]lam ��E/ Lld �' G�Pnf���/r�'r,6hf f,� Do 61Y� <br />jD' PIC. 1(gO6r,.l �an �+tC lei — �foQ—/2S/Zz <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Chec <br />Cash <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />) <br />j1$' <br />Sia <br />Z.�L <br />00K1 01q <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />