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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 CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM UATE ISSUED <br />JOB ADDRESS CITY/7/7jP <br />CROSS STREET /V L ew wy^ 51" APNM <br />^/ PARCEL SIZE A'01 <br />OWNER NAME Ab6l9d— - PHONE 6 — T126 -1 7 <br />OWNER ADDRESSP� y` CITY/STATE/ZIP <br />CONTRACTOR ! f ¢�� }C i%� e- e-.% '��GL.Q PHONE <br />I�-5 <br />7! &1)1 <br />'LLp <br />CONTRACTOR ADDRESS 0 I> ® -56 C?CITY/STATEIZIP K1)r1 � L-P7�+ . CA �SSJ i 3 <br />is <br />LICENSE . C-42 I C-36 OTHER I NUMBER a wEXPIRATION DATE_ 3I ZD ZZ <br />WATER TABLE DEPTH: <br />PERC TEST # <br />TYPE OF WORK: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />BUILDING PERMIT # LAND USE APPLICATION # <br />NEW INSTALLATIONDESIGNED / TERNAT E <br />REPLACEMEN U ICE SEPTIC SYSTEM DESTRUCTI O <br />Check#/ <br />ash <br />INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER <br />Date <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />Permit ID# <br />SEPTIC TANK <br />yam" <br />TYPE/MFG - j ( L CAPACITY (0"Oe!5) gal # OF COMPARTMENTS 2 - <br />Ll <br />❑ GREASE TRAP <br />TYPE/MFG CAPACITY __ gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION > I19 ft PROPERTY LINE N.3 0 <br />❑ LIFT STATION <br />_ft <br />SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />LEACHING CHAMBERS # OF LINES LENGTH OF LINES 7 ' <br />fl <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ FILTER BED <br />WIDTH ft LENGTH ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE _ _ <br />It <br />❑ MOUNDED <br />WIDTH ft LENGTH _ ft DEPTH <br />It <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />ft <br />❑ SUMPS <br />WIDTH it LENGTH It DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />It <br />❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />ft <br />A�,. <br />SEEPAGE PITS <br />NUMBER a WIDTH �t ft DEPTH Z S <br />It <br />DISTANCE TO NEAREST WELL ft FOUNDATION /bD tft PROPERTY LINE !O <br />f; <br />1 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 />MINIMLMQJ40UR <br />ADVANCE NOTICE REQUIRE) OR INSPECTIONS - PLEASE CALL 953-7697 <br />SIGNED <br />TITLE Js'ftr-g- DATE D—ZyZ�Z <br />Application Accepted 6'w <br />Final Inspection By <br />Character of Soil to Depth of 3 <br />COMMENTSDOri9 n <br />Date D 'L Area / / / Employee ID# <br />Date 2 , ( SPECIAL PERMIT - Approved by . <br />Pi Sum Soil Character: <br />f <br />Y <br />c <br />PE <br />Code <br />Sc Received <br />INFO B <br />Check#/ <br />ash <br />Amount <br />emitted <br />Date <br />Permit] <br />Service R uest # Invoice # <br />Permit ID# <br />42141 <br />4/14/18 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />