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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-KEFUNDABLLE HERMIT `I GALL LU.9Yb3-/UYI FOR INSPECTIONStXPIRES I YEAR FROM UATE ISSUEI <br />Y <br />JOB ADDRESS `�3! �^ Y,,+4A iK Som ,^^ fz CITY/ZIP ", Yc/ +--e-4 C►4 S <br />CROSS STREET j L) �+ � APN % <br />OWNER NAME V �q jG�i 6✓�� 9 n v� 1`�S �Yec i. PHONE(') —vU, �-( <br />OWNERADDRESS�/►/�(J �/ NU L' II��s CITY/STATE/ZIP R%YILjy(iY•t-c; % S 37 <br />CONTRACTOR I y ► �`C [, S �reC��G� d—C/ i • PHONE"7 Jlp ",A�^J�p <br />_ 4 <br />CONTRACTOR ADDRESS PO w �O CITY/STATE/ZIP VV L-4ik r,4k Cig( [ -5-3.?C <br />LICENSE ❑❑C-42 ❑FIC -36 OTHER NUMBER 40 EXPIRATION DATE C.a�jf�L <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT #--al 0 W,Q,3 cY LAND USE APPLICATION # <br />TYPE OF WORK: Q-- NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />❑ REPLACEMENT ❑ OUT:9F-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 02 3 <br />P---S—EPTIC TANK <br />TYPE/MFG I" 4L <br />CAPACITY .14M Oa gal <br /># OF COMPARTMENTS OZ <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY gal <br /># OF COMPARTMENTS <br />ya►� <br />DISTANCE TO NEAREST: WELL (60' <br />ft FOUNDATION 10' ft <br />PROPERTY LINE Z S -If- ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ SAND OIL <br />SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />i_7 LEACHING CHAMBERS <br />Received <br /># OF LINES LENGTH OF LINES ft <br />FILTER BED <br />DISTANCE TO NEAREST WELL <br />WIDTH 3� / ft LENGTH <br />'30 <br />FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH b �I <br />ft <br />ya►� <br />DISTANCE TO NEAREST WELL ((-)C> <br />1 <br />(} ft <br />�7 <br />FOUNDATION O ft PROPERTY LINE ! s ft <br />❑ MOUNDED <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION 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 />MINIMUM 48 HOUR A VANCE NOTICE REQUIRED <br />FOR INSPECTIONS - PLEASE CALL 209) 953-7697 <br />SIGNED <br />TITLE r1 i G IL,3 f DATE T � <br />/0 DEPARTMENT USE ONLY (- <br />Application Accepted By G— LCL_ Date C 21 ZZ Area 5 Employee ID# v <br />Final Inspection By�� Date \IN, by� '� ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS Serves _f(t;4fooMS j P. r Z WI.Sl \-MS \ <br />PE <br />Code <br />SC <br />INFO <br />Received <br />Check#/ Amount <br />Casq Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />ya►� <br />a�� <br />5B <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />