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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 DATE ISSUED <br /> JOB ADDRESS CITY/ZIP 1 vT P <br /> er APN OS3-o70 -054 <br /> CROSS STREET PARCEL SIZE p <br /> OWNER NAME �(��' �// O v ��� PHONE O <br /> :n <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR ( yV(1��� I �/�I i1% <' �l/'/ PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE 11)(42 ❑nC-36 OTHER NUMBER G EXPIRATION DATE <br /> I 1 <br /> WATER TABLE DEPTH:L� % ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: Li NEW INSTALLATION REPAIR/ADDITION Ll ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I 1 DESTRUCTION <br /> NJ <br /> INSTALLATION WILL SERVE: [ RESIDENCE COMMERC ❑ OTHER <br /> IAL <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: A NUMBER OF EMPLOYEES: <br /> ❑ 'z/SEPTIC TANK TYPE/MFG v/ 4L 7 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 LEACHING CHAMBERS #OF LINES LENGTH OF LINES fjTu ft <br /> DISTANCE TO NEAREST WELL / ft FOUNDATION 4(O ft PROPERTY LINE / / ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE T 2NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER ✓ WIDTH ft DEPTH �J`r ft <br /> DISTANCE TO NEAREST WELL l�0 ft FOUNDATION /60 ft PROPERTY LINE Sd 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 ADVANCE NOTICE REQUIRED FOR INSPECTIONS - LEASE CALL 209 953-7`697 C� <br /> SIGNED TITLE DATE ///&' <br /> r10A ab <br /> o <br /> H <br /> Fr <br /> EPARTMENT IJSE ,6NLY <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By b " Date �Z_I \Q ❑ SPECIAL w— PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS G <br /> PE SC Received Chec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash emitted Service Request# <br /> 1D •Ig (� <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />