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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 FORINSPECT/ONS EXPIRES 1 YEAR FROM DATE ISSUED <br />Joe ADDRESS 3-24'P4' 7-305-0 5, F0kED,C_X1Ct_' CmrzIP (ZIIPbppj o <br />CROSS STREET Lo I Pop- 2-1i . APN ..2-14 "� ,3 0 ' L7 ^ i.,p , Z.q PARCEL SIZE ) <br />OWNER NAME E I L EE ,1J , I KV I L- PHONE S-7 ! - `45 to a ,U <br />OWNER ADDRESS Z 2 �+ q `r 5' •F12 E D E R 1 CK CRY/STATE/ZIP X I PG AJ CA ` �34e (01 <br />CONTRACTOR LIVE QjNW- GCOEIVy1(ZOrV141EA!'ir1L PHONE 340q-03' 5 <br />CONTRACTOR ADDRESS '401 w - CAV— 5T-. CRY/STATE/ZIP LE)�> ( c -A (S'2-4 0 <br />LICENSE 00C-42 000-36 OTHER L E&- NUMBER 2.1 i I EXPIRATION DATE T -3 V - Z-4 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # 3 BUILDING PERMIT # LAND USE APPLICATION # ` '2 of O�-z <br />TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION 0 ENGINEER DESIGNED/ALTERNATIVE <br />❑ REPLACEMENT LI OUT -OF -SERVICE SEPTIC SYSTEM 0 DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL 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 />f::l LEACHING CHAMBERS <br />Check#/ Amount <br /># OF LINES <br />Code <br />LENGTH OF LINES ft <br />Ca h Remitted <br />DISTANCE TO NEAREST <br />WELL <br />sa3 <br />ft FOUNDATION <br />( L � Oo8473�' <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH It <br />DISTANCE TO NEAREST <br />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 />Oj . <br />DATE ':F - '4 ` 2-Z <br />a <br />m <br />PAYMENT <br />RECEIVES <br />AUG 18 2022 <br />SI N JOAQUIN COLIN <br />ENVIRONMENTAL <br />HEALTH DEPARTMEI <br />VEC <br />2022 <br />=NTAL HEALTH <br />/SERVICES <br />DEPARTMENT USE ONLY <br />Application Accepted By Date Area �% �% Employee ID# <br />AG - <br />Final Inspection By Date ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character) <br />COMMENTS P,�Jrna T Auniber Cavlr.a fee< h,F15le i r,:,vlerr,,aPr'/ - lac - -, I I-- ]T; LA (2-1 <br />PE <br />Sc Received <br />Check#/ Amount <br />Permit/ <br />Code <br />INFO <br />Ca h Remitted <br />Invoice # Permit ID# <br />ate Service Request # <br />Naaa <br />sa3 <br />( L � Oo8473�' <br />41 <br />4//1414/18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />